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<� s—.��s� :. <br /> i <br /> Date � �J � PublicWoiksPenn p �y^ <br /> Application For eiae�oeo�.� `s � / <br /> PUBLIC WORKS PERMIT PUbToalFaeFee s <br /> Less Fppt Fee Paitl g 11 <br /> Baiance Due $ /� �� <br /> Print or Type Only <br /> �l[. VE��S �4� �6PE�r/Ff I�O�G� I�73 d�y/U�II GJ6D0 C/�� <br /> Owner Mailing Atldress C�ty Zip Phone <br /> ` qPp���a�� ~ Mailing Address Gty Zip Phone <br /> Dc�scribeProposedWork ��-� ���`� � � S�—'l`F ����'�"�" ����6� <br /> - W <br /> Project Address(if known) _L.,L—;���='�`' 'S � "�" �'., 'S � <br /> Atlach four(4)copies of plans(or proposed worY.- Draw to scale and note the tollowing as applicable: A � <br /> � • Properly Lines • Centerline ot street � <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 /M <br /> W <br /> UO NOT WRITE BEI..OW THIS LINE o <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection sha�l be made 24 hrs.in advance- phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current Ciry 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•�555. � <br /> j� T BE Cc,r�s:,t'vc.-Eo /�'�.e si�'.°,e'ovF� o <br /> Fc,a.vS D,a�'�� //-/2-:�.5 <br /> � <br /> � <br /> O <br /> , <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims lor damayes, costs, <br /> expenses, or causes of aclion that may arise becaus2 of installation <br /> `-�' ' I/`.i�"' � /� `l���. and mainlenance ot lhe improvement or other righbof-waY use hereto <br /> c'>e'" applied lor and further agreec to remove same upon notice from the <br /> Approved for Co tructio Date City and to replace public property damaged thereby. <br /> FINAL INSPECTI '� '"'-=_'—�'-- "�r� /� �'�jT <br /> Approved as Constructed Signature of Applic nt ate <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 18Q DAYS OF DATE PERMIT IS ISSUED AND THF.REAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPL"cfION. THIS PERMIT MAY BE <br /> Everett WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259•8815 �ROJECT OVER 90 DAYS DURATION. <br />