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�� � 8� - �35�.� <br /> h / / PubllcWa�ksParmlt ���� <br /> Date �� « � <br /> 9leg.Dco�.+ <br /> Application For _ <br /> PUBLIC WOF�KS IP�RMIT PuOToIaIFeaFeP 5 - - <br /> iess Fooi.r*�aa�a S <br /> Balan<e Due $ �J 00 <br /> Print or Type Only <br /> �o��e���7'c,�..e l �3 3i- SC3,wC�� /1i' �v � �s� - �,.3�_ ' <br /> wner MaJing Address Ciry Zip Phone .. <br /> — ` ���""'� Zin Phone <br /> Applicanl Mading Address City <br /> Describe Proposed Work ��V-r� - <br /> �aT�s «�: �z . W <br /> Projact Address(if known) �d�Z�� —v'� �h A��" `S<� . � <br /> �� <br /> Attach four(4)copies of plans for proposed worK� Dra�+to scale and note ihe fol �wmg as applicable: � <br /> • Property Lines • Cen ;rline of stree� <br /> • Outline and dimensions of all existing and • Indii ate North <br /> " � Sho���any proposed gradin� changes <br /> proposed strucWres on the lot <br /> • Existing and proposed utilities • Sho���measurements � <br /> DO NOT WRITE 9ELOW THIS LI�JE � <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be performed in accordance with ihis Aermit and currenl Ciry ot Everett Design and Construction <br /> Slandards and Specifications. <br /> 3. Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•B00•424-5555. � <br /> � USE .QP�i��:uFJf'/ C'ctT 1l!/,9:Cr9BLE o.0 L'AGL fo� O <br /> �,vs.�EOT.o,v co,Jc.E.��u,ti�s ,uEW v.e.vE«!Jy c_vr, <br /> 5. .��y L)9��Ab��'O �iDc N/AGk �GlST aE �C'E�acAc.CO � <br /> 6� T.s%" /�vi't.cA�r ��.cl� nic"�-✓ ¢ c<�vB.eo,�E.✓) V♦ <br /> �, ic/U�.��` Pvr3��c wa�',e.r Oa;cF ?� a��-.s8// c,'P��v � <br /> %Ji:['�G%lG OF L'C+�t/Si.P�/.'>iUN �qUi'�in��/T, � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownerlapplicant hereby agrees�:o hold and save harm- <br /> less Ihe City of Everett Irom any and all claims tor damages, cnsts, <br /> er.penses, or causes of action that may arise because of installation <br /> � L� /J J� �5�� and maintenance of the imp:ovement or other right�o(•way use hereto <br /> hJOb�i'�Z (/ �pplied for and further agrees to remove same upon notice irom the <br /> Approved for dPs 'ict on � Date City and to re�ce public property damaged thereby. <br /> l� � ,� � <br /> , -f t „ �� �� - /� u0� — ��u'�..rr---- <br /> Da�e � <br /> FINAL INSPECTION �� Si�na ure of Applicant Date <br /> Approved as Consiructed <br /> WORK AUTHORIZED BY THIS PERMIT MU.�iT BE STARTED WITHIN <br /> everett PUBLIC; WORKS DEPAFTMENT 180 DAYS OF DAIE PERMIT IS I�SUED ANU THEREAFTER IS TO <br /> � 3200 Cedar Slreet BE DI�IGENTLY PURSUED TO COMPLETION. THI£ PERNI7 MAY BE <br /> Everett,WA 98201 CANCE�LED BY THE CITY UPON ANY STOPPAGF:OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 D'�•YS DURATION. .u,k. <br />