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/��/�. � fuolic works ParmG• ��_.�-- <br /> Date��`� - �� eieo.oeo��� <br /> ApVlicatlon For <br /> P'UBLIC 1N(3�KS RERMIT PuoTotalFeeFee S—�,�� � <br /> �� <br /> iefs R001 Fee PuiE $�- <br /> S o2O��- <br /> Beia�<e Due _ <br /> Print or Type Gnly ',G6 �9 <br /> ��:i . — -, �; <br /> .. � . .. �. i-- �� i' ' � ' .�<: - --��/ "� t` �~ i '� i ( _ <br /> 7! �i:/e n�I� k ��'a � i!r CitY Lp Phone <br /> Owner Mail�ng Address <br /> r Nr�� G:i••l�. <br /> -� j � J <br /> f�n,�-c' S . , � Cc;ci(z�� '^ C"� ',.>� S' C i ,— <br /> y i � � � � �v •i CitY Zip Phone <br /> � Applicant !dailing Address <br /> : -� <br /> r : ( , _'"r ; , .'� ^'' �-�,'h' `-� ' ' ' _ <br /> Gescribe Proposed WorR� <br /> Project <br /> Address(if known) ���� �� �/� ��� S E _ � ' <br /> e� <br /> Attach lour(4) copies of plans for proposed work• Draw to scale and note lhe lollowing as applicable: � <br /> • Properry Lines • CeNerline ot streel <br /> O Outline and dimensiors of all existin�and • Indicale North <br /> proUosed sVuctures on ihe lol • Show any proaosed greding changes <br /> • [xisling and proFosed utilities <br /> • Show measw-�ments � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONOITIONS � <br /> 1. P,II r.alls lor inspection shall be made 24 hrs. in advance- phone 259•S81 5. <br /> 2. All vnrk shall be performed in accordance e�ith this permil and current City of Everett Desi�n and Construction <br /> Standards and Specifications. � � <br /> 3. Cell Location Ur�deryround Service 48 hrs. be(ore you dig TpLL FHEE NUMBER 1-800•424-b555. <br /> � r. <br /> C: <br /> � <br /> � � <br /> � � � <br /> Ul : <br /> � r �. <br /> N <br /> r< '. <br /> a <br /> ACKNOWLEUGEMENT OF GONDITIONS ',-^: �� <br /> The undersigr�ed owner/applicant hereby agrees to hold and save harm- � ; <br /> less the Gity of Everelt from any and all claims lor damages, cos�s, , , � <br /> expenses, or causes of zGion lhat may arise b�.;causr. of mslall:�tion -2 <br /> /��/ o �� �J"�/ and maintenance of !he improvemen� or other righbol-way use hereio _ <br /> � O 7 ypplied for and luriher agrees to remove same upon netice Irom the <br /> Ap ove for C str� ion �a�e City and to replace public pr�perty damaged thereby. _- <br /> � � � � � . = <br /> ���L MP�� �`�� `JS • �� �� �_ ,.�/� � <br /> Date � Date �' <br /> FINAL INSPECTION Si ature ol Applicant " <br /> Apprcved as Consuuctzd <br /> WORK AUIHORIZED BY THIS PERMIT M ST BE STARTED WITHW ` � <br /> I �� -�t PUBLIC WORKS DEPARTM NT �g0 DAYS OF DATE PEHMIT IS ISSUEU AND THEREAFTER IS TO <br /> 3200 Cedar Street BE DILIGEWTLY PURSUED TG COMF'-E710N. ?1115 PERMIT MAY E3E <br /> � Everett,WA 98201 CPIJCELLED �J1'7ii:� ���ITY UPON i•NY;TOPPAGE OF NlORV<. GN TfIIS <br /> Phone: 259-8815 'r'i;OJGCT OULR 5i� D:1'S DURATIO�J <br /> I <br />