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_ __ . _ __ f :� <br /> i <br /> , <br /> I, :� <br /> ( �. <br /> � <br /> ; <br /> i <br /> I <br /> Date n�� '(� 1 a�m�wo„sae� `�I / —�3 ' '�' <br /> eiaa 000i., _���(�__ ;�� <br /> AUDlication For � <br /> ��� <br /> PUBLIC W�QRKS PERMIT P�������N.o«SF�e-------- ' <br /> TotN Fec $-- - ;�,� <br /> �ess.�nol Poc Par� u �� <br /> 2�>�"' <br /> e,�a�«o��� S .. <br /> Print or Type Only _ <br /> �i <br /> .�C.�r l� �k ��,.�:Fl����< <� l�yv C�il��� 2 f31�'c�! ��a��.� <br /> Owner Maihng�ddress CitY Lip Phone � <br /> <-i;��Y�r�N if���� , ��-�;11� <br /> Apphcant tvlai6ng Address City Zip Phone <br /> Describe Proposed Work =��� � � � l_.{-�l.L\.1-�� f l[��� I <br /> - W � <br /> �� __�� - _������� .� , <br /> Project Address(if known) � — � �-- - �'1 � � <br /> Attach lour(4�copies ol plans for �roposed work- Craw to scale and note the lollowing as appi'cable: � <br /> • Property Lines • Centerline of street � <br /> • Oulline and dimensicns ol all existing a��,d • Indicate Nonh <br /> proposed slructures on ihe lot .'�' • Show any proposed�lrading chanc�es <br /> • Existing and proposed utilities • Show maasurements � <br /> DO NOT WRITE BEl OW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1.All calls for inepection shall be made 24 hrs.in advance-phone 259•8810. � � <br /> 2.All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction i <br /> Standards and Suec�fications. <br /> 3.Call Location Underground Servlce 48 hrs.before you diy.TOLL FREE NUMBER 1•800-424•5555. � <br /> � <br /> � <br /> � � <br /> O I <br /> a � <br /> ��/, ACKNOVdLEDG[MENT OF CONDITIONS �, <br /> �^/V', Th��undersigned owner/applicant hereby agrees Io hotd and save harm� ' <br /> Iess Ihe City ol Evecett from any and all claims lor damages, costs. I <br /> y// � expenses, or causes ol action thaf may arise because of installation � <br /> •-�%;/�f��,,,,/., � �y ,�� and main�enance ol �he improvement or olher right-of�way use hereto <br /> ' ' applied lor antl lurther agrces to remove same upon notice Irom thc , <br /> Approved lor Consiruc On Date Ciry and to replace public property damaged thereby. <br /> �r � �-/-Fj /( <br /> FINAL INSPECTION Date �-=- \ t l'�`�'r�--� S I � <br /> Apprcved as Conslruc�ed Si�na u����ppllcant D t�� , <br /> everelt PUBLICYlORKSDEPARTMENT WORK AUTHORI2EC BY THIS PERMIT MUST QE STAHTED WITHIN � <br /> � 9200CedarStrect 780 DAl'S OF DATE PERAIIT IS ISSUED AND THEHEAFiER IS TO � <br /> Everett,WA9B201 BE D!LIGENTLY PURSUC-D TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY TI1E CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVEfl 90 DAVS DURATION. <br />