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�` <br /> ——� <br /> � <br /> F <br /> a <br /> � <br /> � <br /> . Date S��p3 Pu�l!c WOAw Permil x �� ' Z I <br /> ApplicetionFor aioc.oeo�.• � � <br /> � <br /> PUI3LIC WORKS PERMIT PubllcWorbFee s�o= , <br /> Total Fae <br /> � <br /> Leae Aopl Fee Pald � ^ <br /> Balence Oue S <br /> d�� <br /> Print or Type Only 6�8.j� '� <br /> �unN��er � ��ot1 �28'��'rSw �UereJ`� cj8ac>�� 353- �aa <br /> Owner Mailing Address City Zip Phone <br /> >u0.ne �r� z�o�i �z�$sw � �er�� �'i �� oJ 353-��aq <br /> Applicent Mailing Address City Zip Phone <br /> Describe Proposed Work ��`�-Lr—, �'e � 1�e V�C�. . _ <br /> �I � � W <br /> Project Address(If known) �S1J O� y +— �r. S.E . � <br /> Attach four(4)copies of plans fo�proposed work- Draw to scale and note the following as applicable: � <br /> • Property Linns • Centerline of street � <br /> • Outline end dirnensions of all existing and • Indicate North <br /> propased siructures on the lot • Show any proposed grading changes <br /> • Existing and proposed utllities • Show measurements M <br /> DO NOT WRITE BELOW THIS LINE O � <br /> PERMIT CONDITIONS <br /> 1. All calls tor inspeclion shall be made 24 hrs in advance- phone 259•881 5. � <br /> 2. All work shell be pedormed in accordance with this pF�mit and current City of Everett Design and Consiruction <br /> Standerds and Specifications <br /> 3. Call Location Underground Service 48 hrs.Eetore you dig.TOLL FREE NUMBER 1-500•424•5555. � � <br /> O <br /> � <br /> � <br /> O I <br /> a � <br /> ACKNOWLEDGEMENT OF CONDITIONS �, <br /> The undersigned owner/applicant hereby agrees to hold and save herm• j <br /> less the City of Everett trom any and all claims for damages, costs, <br /> expenses, or causes of ar,tion that may arise beceusa of Installation i <br /> _ s�� �� and mai nce of the improvement or other righboi•wey use hereto <br /> app for an further agrees lo remove same upon notice irom the <br /> pro• for Construction Date y and to ace public properry demaged thereby. <br /> . �) `' 91 J7'9 3 <br /> , ,�. <br /> FI AL INSPECTION Date , <br /> Approved as Constructed Sig ure of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE ED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED ADVB�f EREAFTER IS TO <br /> � 3200 Cedar Streat BE PILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MA1' BE <br /> Everett,WA 98201 CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON 1'HIS <br /> Phone:259•8815 PROJECT OVER 90 DAYS DURATION. <br /> � �1 <br />