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i <br /> � <br /> Date �''_�� PuElic Works Pem��t a �����_ I <br /> Application For 6. oe"i.+_ � <br /> i <br /> PUBUC WORKS PERMIT PublicWork4Fen s_ �, <br /> To1al Fee <br /> Less AOPI.Fee Ppla � i <br /> Balancc Due $ �O� � <br /> Print or Type Only ' <br /> �• <br /> �o�., �2r�t,�Y i l3a -`i� Sf'Sw�+'�o ��e�t��7.d�{- 353'a4 8`? <br /> . Owner Mai4ing.4ddress City Zip Ph°�e il <br /> S�t�.� � <br /> Applicant MailingAddress City �i�� Phone � <br /> �L. 1 /' 11 I <br /> Cp'1�4TY'UCT �W S��'1�12 'K�T'i�14 �Si�CCr.�Ge I� <br /> - Describe Proposed Work — ��, <br /> � � �� 1� � n ! �IdLl�^ �r IlS f�S <br /> � <br /> 5.30� - �-��'=`�A�_ �. � ' <br /> : Projecl Address(if known) � <br /> Atlach four(4) copies of plans for proposed work- Draw to scale and note the following a:,applicatle: � �� <br /> . � Properry Lines • Centerline of streel � �� <br /> ' • OuHine and dimensions of all existing and � Indicate North <br /> . proposed struc:ures on the lot • Show any pruposed grading changes . <br /> , • Existing and G'oposed utilities • Show measurements � <br /> � DO NOT NRITE BELOW THIS LINE O I <br /> � PERMITCONDITIONS , <br /> �� 1.All calis for inspection shall be made 24 hi�.in advance-phone 259•8810. � <br /> _ 2.All work shall be pedormed in accordance H�ith this permit and current City of Everett Design and Constructio�i <br /> � Standards and Specificatiais. �� <br /> . 3.Call Location Underground Service 4B hrs.betore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> � <br /> O <br /> � ; <br /> � I <br /> O I <br /> a , <br /> � <br /> ,/� ACKNOWLE�:JEMEIJTOFCONDITIOPJS � � <br /> �0�'w The undersigned owner/applica�.:�. .�t�eby agrees to holC and save harm- <br /> less the City of Everett irom :�.uy a^d all claims for damages, costs. <br /> f / expenses. or causes of aclior. ihat �nay anse because of installation <br /> / P /7 dg and maintenance ol the imprcvament or other right-ohway use hereto <br /> o n applied lor and furih� a3rees to remove s,ime upon notice from the <br /> Approved for onsti`ij�•ion Da;e City and to replace� ��n'ic prooerty damageu theraby. <br /> P� <br /> /� %/ (� <br /> ��G� S -/'� •Y•l� ��' � <br /> FINAL INSPECTION ����e <br /> Approved as Constructed Signature ol Ap � ant Date <br /> WORK AUTHORI2ED B THIS PERMIT MUST BE ST�.RTED WITHIN <br /> everett PUBLICWORKSDEPA!iTMENT 780 DAYS OF DATE P[RMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS pERMIT MAY BE <br /> Everett,WA 98207 CANCELLED BY THE CI7Y UPON ANV STOPPAGE OF WORI<ON THIS <br /> Phone:259-8810 pROJEGT OVER 90 GAYS DURATION. <br /> ( <br /> i <br /> � <br />