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�a���•��i Pu�l¢Yw�ksPeimit• `� � � � <br /> l <br /> Application For em9.000��• <br /> PUBLIC �JV�RKS i�ERMIT Pu�IlcWarkSFae — <br /> Tolal Fee S �� '�G <br /> :as�Appl.Pex Paitl 5_— <br /> 3alance Duo $_.a`�'�O <br /> Print or'ype Only <br /> ,��'/a.s <br /> S7ANnra �D PA�ir=ic N ��' co2t� �3��q ��¢�i�vsF�ll�} �3E'LLF��u� a��l:. <br /> Owner Mailing Address City Zip Phone�s� ^ /5—� v <br /> � h+ �� <br /> Applicant Mailing Address l.iry Lp Phone <br /> Describe Prcpc�sed Work �� `� ��1�-��1i�'-�Y � �` '�- n J �� <br /> fYa� <br /> Preject Addr2ss(il known) �� 0� �� ��• ��"— � <br /> Aitach four(4) copies of plans tor proposed work- Draw to scale and note the following as ap�licab!e: o� <br /> •�Property Liras 9 Centerline of sireet � <br /> • Ou�line and dimensions of all existing �:nd • Indicate North i <br /> proposed structures on the lot O Show any proposed 9radin� changes <br /> • Existing and propo�,ed utilities e Show measure�rients � <br /> DO NOT WRITE BeLOW THIS LI?�E � <br /> PERMIT CONDITIONS <br /> 1. 411 calls for inspection shall be made 24 hrs. in advance- phone 259-P81 5. �y <br /> 2. All work shall be per'rormed in accordance with this perrzit and current City of Eve�ett Design and Construction ♦ <br /> Sta+dards and Specifications. <br /> 3. Cali Lccation Underground Service 4•9 hrs. Gelore you dig.TOLL('F;GE NUMBER 1•800•42^•.`��5. � ��_ <br /> F <br /> V/ r <br /> [-. <br /> y�p <br /> M/ ~ <br /> H � <br /> � tf, r <br /> c r;. <br /> � - . <br /> J <br /> ACKNOWLEDGEMENT OF CONDITIONS '�; <br /> The undersiyned owr�er/applicaN hereby agrees to hold and save harm- F' � <br /> - less the City of E •erelt from any 2nd all claims br damages, costs, � <br /> �_� �� — expenses, or cause.� oF aclion ihat may arise because oi installation �� <br /> a� r�,�y and maintenance �t �he impwvemen` or other right-oi-way use hereto �� ! <br /> applied for and further agrees to remove same upon rotice Irom the <br /> Approve or struction Date Cily and te replace puolic property daTaged thereby. ;; <br /> �� Z-' �"� � - 3 ` . <br /> FINAL I SPECTION Date �'� � � � � �� � <br /> Appra�ed as Construct Sianature ot ApplicaN Date _ <br /> PUOLIC WORKS EPARTM NT 'NORK AUTHORI'ED BY THIS PERMIT MUST BE STARTED WITHW ya <br /> everett I80 DAYS OF OATE PERPdIT IS ISSUED AND THEREAFTER IS TO , <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. 1'HIS PERMIT IdAY BE <br /> Everelt WA 9d201 CANC[LLFD 6Y THE CITY' UPON ANl'STOPPAGE CF WORK ON THIS <br /> Phone: 253�8815 PROJ[CT O.[R 50 DFlYS DU RA"�ION. <br /> l-- . � <br />