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Date_LlG=/1� � PubllcWorksPer �. �f.�7"� <br /> eia9.oeo�._ � <br /> Application For _ <br /> PU�LIC WORKS PE6�MIT PubTolaFoeFoc e <br /> Less AO��Fea PaiA � <br /> �alancoDue g ���_ <br /> Print or Type Only � <br /> L�1z�n� i k - - l' � �' � ' � �'�' L_�a��� <br /> Owner Mailing Address City Zip Phone <br /> � '°.P����JC�,� ��'�-flP,� �/c7 � k=i7a!?-�ttl7 ,%,�J!a �R2-L��/ ��°3� �7� <br /> Applicant <br /> Nladmg Address �/ City Zip Phone <br /> Describe Proposed Work �.�LG.� � ��' ` <br /> i <br /> � <br /> - � I <br /> �<5'/5�- /O��i>,E? SE L.�T's`a9 0�' !�. ': <br /> Proiect Address(if known) /y�T�� i�E«� �!� r <br /> � <br /> Attach taur(4) copies of plans for proposed work- Draw to scale and note the following as applicatle: � <br /> • Property Lines . • Centerline of slreel <br /> • Outline and dimensions of all existing an� • Indicate Nor:h <br /> proposed strucWres on lhe lot • Show�ny proPosed grading changes <br /> • Existing and proposed utilities o Show measurements /� i <br /> W <br /> DO h'OT WRITE BGLOW THIS LINE � ��. <br /> PERtAIT CONDITIONS ' <br /> 1. All calls for inspection shall be made 24 hrs. in advance phone 259-8815. � <br /> 2. All work shall 6e performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Soecilications. � <br /> 3. Call Location Undere,round Service 48 hrs. betore yoi�dig.TOLL FRE'e MUMBER 1-800•424-55�5. <br /> v <br /> �w <br /> _N <br /> � <br /> � <br /> �,, ACKNOWLEDG�MENT OF CONDITIONS <br /> i <br /> �4-�� The undersigned ovrner/applicant hereby agrees to hold and save harm• <br /> less lhe Ciry ot Everetl 'rom any and all claims for damages, costs, <br /> expenses, or causes ol action thal may arise because ol installation <br /> '�� � �' / / �/ ,ani maintenance of the improvement or other righPohway use nereto <br /> �=!,( � �C'Zr7�—r U%G ��_Z �applied for and further agrees to remove same upon notice trom the <br /> Approved for Constru tion �a1e City and to replace public�p�Opesty�damaged ihereby. <br /> i;�.� � �; <br /> z-� � ;! ; � � �. � <br /> Date � �' �"`✓" `� <br /> FINAL WSPECTION Signature of Applicant � �ate <br /> Approved as ConsV�.:ted <br /> WGRK AUTHURIZED BY THIS PERMIT MUST BE STARTED VJIiHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 OAYS Of DATE PEHMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Sireet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br /> ` <br />