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Date_/�,�J,—�—r��[/D �r Pu�bc Works Permll r`)� ��—Z�'j ' <br /> / Blag.Deo���---_<<�+F�"� <br /> Application For <br /> Pl1BLIC WORKS PERMIT °°°';°`"°`"'Fa° <br /> Tolal Fee $ <br /> LessAD���Fee Peld $ <br /> Balanca Due 5 "���� <br /> ?rint or Type Only <br /> (i n OD (d � �:;� a,� �190 9 —�%71�r Gtiv 1�' r^'��o��.f'a� 9�f'o2p� ' -�J ', <br /> � e� � MaJing Address Ciry ZiU P one <br /> qPPT�'"ji�a�� ` Mailing Address Ciry 2ip Phone ., <br /> Describe Proposed Work , <br /> D,en � <br /> Prelect Address(if known) �J f 7 —[��r � ��`� Y�, - � <br /> �- <br /> Atlach four(4) ccpies of plans for proposr,d werk- Draw to scale ard note the following as applicable: � <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimensions of all existing and • Indicale Norih <br /> proposed structures on the lol • Show any proposed grading changes <br /> • Existing and proposed utililies • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMI' COiJDI110N5 <br /> 1. All c,��:s for inspection shall be made 24 hrs. in advance- phone 259-881 5. ^ <br /> 2, All woin shall be pertormed in accoWance with this permi� and currr,d City ot Everelt Design and Construction ♦ <br /> Standards and Specifications. <br /> � :,. Call Location Underground Service 48 hrs. before you dig.TOLL PREE NUMBER 1•800•424•5555. �y <br /> / / � <br /> 7. �Y/2flOE GDTS Sp /�S itJOT 7U Ih��qCT �SiJ,t',�'OUNOiN� O <br /> GoTs u/rTi� /1Br•c/C.c/9T�',c� .L'ur>�<�;� <br /> �7. ..��y ��,�,�G�- ,a 5,������� , ��.�� � ���,7�-,� F <br /> cS'NP,L!_ (�'E f��_/.iS'c{-L� f,'- � %r,-'F ���P/ii-Fli,/T � <br /> O <br /> a <br /> A�KNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the Ciry ot Everett Irom any and all claims for domages. costs, <br /> expenses, or causes ol action lhat may arise because of installation <br /> s�/ /n and maintenance of the improvement or other righ4ohway use hereto <br /> � � ,�f[.-. — - � "' /� `�� applied for and furlher agrees to remove same upon notice Irom the <br /> Approved lor C6nstruction Date City and to replace public property damaged thereby. <br /> � 2(_z �? �}1nUorro (,Jlu�n�u `7 �3- ��O <br /> FINAL INSF'ECTION Date � <br /> Approved as ConstruCted Signalure of Applicant Date <br /> WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTEO WITHIN <br /> everPit PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PFRMIT IS ISSUED AND "'HERERFTER IS TO <br /> � 3200 Cedar Sireet BE DILIGE�TLY PURSUED 70 COtdPLETION. 7NIS PERMIT MAY BE <br /> Everett WA 98207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TH!S <br /> Phone: 259-8875 PROJECT OVER 90 DAYS DIIRATION. <br />