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_,�..�,„� ..: � <br /> oate 1 1? gf, � . .. . . . �, .;�:r <br /> Puolic Worka Parmit R "" � �� / <br /> APPlfcat(on For em9.wo�.s�z�J.r <br /> PUBLIC WORKS PERMIT Pu�7olalFeaFee s <br /> iass noo�Fee va�a S <br /> Print or Type Only Balanca Due S 2�— <br /> � �3q/� <br /> ��3�C�Cb�uS 1. In�� . 4232 13�t P�.sW . tq,i,�o p� 9u 1� 7Y ,�s� <br /> Owner MaiHng Address City Zi <br /> P Phone <br /> SAn.�� A-S �4BoJL <br /> Applicant Mailing P.ddress City Zip Phone <br /> Describe Proposed Work C'r�°�•i ��;^ /F— �- . �� �j V � L� D Q LC X <br /> —�_ <br /> �'7v9 =� —��' B _ ��.: = .sr, W <br /> Pro�ect Address(if knownj . .� � <br /> Attech four(4) copies of plans for proposed work•Oraw to scala:�nd note the following as•ipplicabie: ' <br /> • Property Lines • Centerline of:;treet s <br /> • Outline and dimensions of all existing and • Indicate North � <br /> proposed structures on the lot . • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELC�W THIS LINE � <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259•8815. <br /> 2. All wo k shall be pertormed in accordance with this permit a�d wrrent City of Everett Design and Construction � <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOIL FREE NUMBER 1•$00•424•5555. <br /> � <br /> 2���� �c—v��_�� ���=--� �—� Q <br /> � �'("c1��-"c` .�5' t.-� m-t� �,� `�� � <br /> ���/.l�iic2',a'�c"G�j //� <br /> / � O <br /> � <br />, a <br /> ACKNOWLEDGEMENT pF CONDITIONS <br /> The undersigned owner/applicant hereby agraes to hold and save harm- <br /> . less the City ot Everett from any and a9 olaims for damayes, costs, <br /> expenses, or causes of action that ciay arise .- �,ause of insta�lation <br /> GZ and maintenance of the improvement or othei right-ohway use nereto <br /> �e�ons u ion Date applied for and turther agre�s to remove saniP upon notice (rom the <br /> City and t replace public property damaged Ihereby. <br /> i / 9 <br /> .acC ,�= 2 2 -,f� i/� j <br /> rIFAL INSPECTION �` �.�% S L <br /> Approved as Constructed Da1e nature of Applica � V �/ <br /> / • tv <br /> everett PUBLIC WORKS DEPARTMENT ORK AUTHORI BY IS PERM7T MUST BE STARTEp lVf(HIN <br /> � 3200 CedarStreet � �80 DAYS OF TE PE MIT IS ISSUED AND THEREAFTER IS TO <br /> Everr,�tt,WA g8201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMII'MAY BE <br /> Phone:259•8815 CANCELLED 8'r THE CITY UPON ANY STOPPAGE OF WORK UN THIS <br />� PROJECT OVER 90 DAYS DURATION. <br /> L <br />