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�' Pu01it Works Pe�mit r N � /J� <br />��/te_���� <br /> Bldq.�epl.+ <br /> Application For <br /> PUBLIC WORKS PERMIT PueTo�FeeFee s <br /> Less AppL FBe Paie S �] ' <br /> BalanceDue s �`���� , <br /> Print or Type Only ! <br /> �acman � � T�,i y7/l ��m Ever��T% I,Ja. 99�03 a.ra-9�/�o I <br /> Owner Mei4ing Address City Zip Phone I <br /> i, <br /> Frn �s� � a8 O /-f�w%ri ,��r �7'T I.Jn 9vaoi 33s-�scs� <br /> Applicant Mailing Address City Zip Phone j <br /> I � <br /> � • n s � h //EIS <br /> Describe Proposed Work , <br /> ,, ,• � b <br /> W <br /> Prolect Address(if known) <br /> �,' F / 7ti OS`� S;�vcr �a.�t Sk? CO A�• � <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 struclures on the lot � Show any propoced grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br />� DO NOT WRITE BEI.OW THIS LINE O <br />� PERMIT CONDITIONS <br /> 1. All cails tor inspeclion shall 6e made 24 hrs. in advance- phone 259•8815. � <br /> 2. All work shell 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 FREI':NUMBER 1•800•424-5555. � <br /> S� TFM�v,edQ�/ E,eos�*//sE�i�n�..�iv�c� l'ntiT,eoL O <br /> T f�' .T�vsr,a«�-v �fs ,r>>,e�'crF.� df/ 7'.yE � <br /> c,y � ��F,�:,T �,B�.c wo,�s� z�'Sr�E�r�, N <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and sava harm• <br /> less the City of Everett from any and ail claims tor damages, costs, <br /> ezpenses, or causes of action that may arise because of installation <br /> � 7 / � and maintenance of the improvement or olher right-obway use hereto <br /> ����� �--� �F - /35 ypplied for and further agrees to remove same upon notice trom the <br /> Approved for Const/ru�eron- � City and to replace public/p�DPe�'rry dama9ed thereby. <br /> ✓' / �' � l�?r-� �._ <br /> FINAL INSPECTI Date � � Date <br /> Appraded as Constructed Signature of Applicant <br /> 1 WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evereti PUBLIC WORKS DEPARTMENT �g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEfi IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON 7HIS <br /> Phone: 259-8815 pROJECT OVER 90 DAYS DURATION. <br />