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_ _ <br /> Date���S a��r�wo« ���m�i. ='�'G - -3 <br /> Application For emq.oeri.x� � /�S�' � <br /> �'UBLIC \INORKS P��pJIlT Pu�licWorksFou <br /> To:nl Pee 5 <br /> Less Fppl�`:e PaiJ $ <br /> 6aiance Due $ 4 C'J C��/ <br /> Print or Type Only 0�.� — <br /> �3 <br /> ��Pi Pa ��- . I�S.E L� vP/P �f Y{�i II GUGa fu�7� � 7��l�J `` �i��-3�.� <br /> Owner Mailiny Address City Zip Phone <br /> S'a �M �P <br /> Applicant Mailing Address City Zip Phone <br /> i _/ <br /> Describe Proposed Work �f �i � res� U PN I�_ . <br /> — i <br /> C - W <br /> Project Address(if known) �Q��q - �Q �J� J � CGT /9 - j„eE`�,�� � <br /> A4ach four(4) copies of plans for proposed�vork- Draw to scale and note the followin9 as applicable: � <br />. • Property Lines • Centerline ol sireet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on thP lot • Show any proposed gr2ding changes <br /> • Existing and proposed utilities • Show measureinents � <br /> DO NOT WRIT[ BELOW THIS LINE � <br /> PERMIT CONOITIONS <br /> 1. All calls fur inspection snall be made 2A hrs. in advance•phone 259•8£31 5. � <br /> 2. All work shall be performed in accordance with this pe�mit and currenl City ol Everetl Design and Consiruclion <br /> Standards and Specitications. <br /> 3. Call Location Underground Servi�e 48 hrs. delore you dig.TOIL FREE NUMBER 1-8Q0•424-5555. � <br /> 4. :�ny grading of this lot is to b� done so as not to impact the adjoining lots <br /> with rain-water rwz-off. O <br /> 5. Sidewalk is new and unbroken. Any damage to it will require replac�nent by <br /> the applicant. <br /> 6. Eiaul organi.c material !?�r.ush, stumps, trees, etc.) off lot. � <br /> M/ <br /> 0 <br /> ii <br /> ACKNOWLEDGEMEN7 OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and savc harm- <br />- less thr. City of Everetl from any and all claims for damages, cosls, <br /> expensc:,, or causes of action that may arise because of installalion <br /> /��!�/ and maintenance of the improvement or other right�cf-way use hereto <br /> � .�-.. ��-'��-" �cT"� /����S applied for and further agrees to remove same upcn notice from the <br /> Approvel for Con uction � � Data City and to replace public property damaged Ihereby. <br /> , �7-23-5� ,��/ � ��� 7��,� <br /> FINALINSPECTION Uate _;`��?�-����i�� v�'"�''�X"�— <br /> Approved as Consiructed SignaWre of AGPlicant Date <br /> everett PUBLIC WORKS DEPA MENT �✓�RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett, WA 98201 8E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259�8815 GANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />