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` �. <br /> �8t8�LL_ . � _ PuUlic Works Permlt s <br /> I ApplicationFor BIU9.Oepty �� Z <br /> PUBLIC WORKS PERMIT PubToalFeeFee s <br /> l esa AppL Fee Peid s <br /> Balance Doe S <br /> Print or Type Only <br /> �qr � ����1/`PrioCf' 9d�zvf 7�f3—/ SS.S <br /> Owner Mailing Address Ciry Zip � Phone <br /> iF-1�4�w�a � / }' �(�.5 � I w y �l q .5�,� � � /_,.����, Q�D 37 7�3(SS S <br /> App�icant Mai!irg Ad ress Cit� Zip Phone <br /> Describe Proposed Work _ <br /> W <br /> 7/4 �Prolect Address(if known) _ — <br /> Attach four(4�copies of plans for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structu�es on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> i.All calls tor inspection shall be made 24 hrs.in advance•phona 259-8810. � <br /> �.Atl wark shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br />' 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> /"�cc�nJlc�o-,.�4, Lnu.1/J_�o-f' `J'���-9B O <br /> � ��C.�-�c� <br /> b � � J <br /> �� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett irom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise hecause of installation <br /> and maintenance of the improvement or other right-of-way use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> Approved for Construction Date Ciry d to replac'd�pu6lic properry damaged thereby. <br /> � ' <br /> i � �_ <br /> FINAL INSPECTION Date � ��_ � ��� <br /> Approved as Constructed Signature of Applic t Date <br /> ev�rett PUBLICWORKSDEPARTMENT WORK AUTHORIZ BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA98201 BE DILIGENTLY PURSUEO TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANV STOPPAGE Of iNORK ON THIS <br /> PROJECT OVC-R 90 DAYS DURATION. <br />