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Date �.`� i P�e���wo�ksPa,m��. By 31 <br /> , Application For Bmq Deol.+��/o`XG <br /> PUBL11: WORKS PERMIT Publ�cWorksfee <br /> To�alFee S� �� � O <br /> Z Less AOOL Feo Paid S Z <br /> (s•J.��l Bal.ince�ue S �J J• � � <br /> PrintorTypeOnly Jrd�.,aSe Fez 1��I3(o. v0 <br /> % y %`1 Gyn.�wo�� �Sost 353 - � Z3o �//�`/ <br /> GA�C �Yl��tc�c /S6 �S N« <br /> Owner Mailing Address City Zip Phone <br /> fic=d E�yE�<T iczi�/ �i-i.ti,ci,c.� �Jia:� G-`�eR�-r� q.F2�z/ 7`�$ /3G'7 <br /> Applicant Mailing Address City ZiF Phone <br /> Oescribe Proposed Work �`�c'`� �'�,��'rU�,—/""� z� �-(<�,�r ,/�'`'� �/ T-�' <br /> W <br /> Projecl Address fil known) � Q f � <br /> Altach four(4) copies ot plans for proposed work• Draw to scale and note lhe followinc7 as appliczbla e <br /> • Property Lines . • Centerline of slreet � <br /> • Outline and dimensions ol all existing and • Indicate IJorth <br /> proposed st:ucWres on ihe lot • Show any proposec 9rading changes <br /> • Existing and proposed ulilities • Show measurements /y� <br /> DO NOT WRITE BELOW THIS LINE � <br />' PERMIT CONDITIONS o <br /> 7. All calls for inspeciion shall be made 24 hrs. in advance- phone 259•8815. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. � i <br /> I 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424-5555. <br /> �, l..Ov�,-t!'. p � /��o,�n s o`{' Pro �P� \ - �y-�3�� � hl <br />, � � O � <br /> � H 1— I <br /> N yti <br /> � � <br /> � � F <br /> � �I <br /> a � �_I <br /> � �- <br /> . � <br /> ;p � <br /> ACKNO'JJLEDGEMENT OF CONDITIONS C.� � <br /> � The undersigned owner/applicant hereby 2gree5 to hold 2nd save harm- H � � <br /> less the City of Everett irom any antl all claims lor damages, costs, � c <br /> � �� expenses, or causes of action that may ari;e because ot installation � � <br /> %.�}/_�� and maintenance of the improvemem or other right-o4way use hereto � �� ' <br /> l apGlied for and further agrees to remove same upon notice from Ihe <br /> �Approved for Const tion Date' Ci;y and to replace public property dam2ged thereby. �^ <br /> � � . <br /> ' lv-�G� ,./ : � � ', <br /> FINAL INSPECTION Date � � �� �� - �_ �-/ _ �1 y � � ' .I <br /> i�/ytn! ri tct Q-��r �- <br /> Approved as ConsVucted Slgnature ol Applicant `T�� Dale r <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMI i MUST BE STARTED WITHIN -�%~„ ' .I <br /> � 3200Cedar3reet 180 DAYS OF DATE PERMIT IS ISSIiED AND THEREAFTER IS TO . <br /> Everett,WA 96207 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERId1T MAY BE <br /> Phone: 259-8875 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS �URATION. <br />