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�8t@��� `��+ Pu0licWorksParmil+ /� <br /> Application For eiae�oeo��+ <br /> PUBLIC WORKS PEF�MIT P�o��=W�,ksFea <br /> Tolal Fee S <br /> Less ROV�Fee Paid $ <br /> Print or Type Only Ba'e^=ao�r <br /> " O ne�� tl J(� /n CI�'4 9 AL_!� f ��' �6�� /'ri�rJlPhone �.�"`'/ '��7�' <br /> P <br /> _ ��-�� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work 'F" <br /> n���c� _i <br /> W <br /> Prolect Address�if known) ~ - � <br /> Attach four(4)copies of plans for proposed work- Oraw to scale and note the following as applicable: � <br /> • Pro�erry Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing a�d proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PEI7iN1T CONDITIONS O <br /> 1. AI'calls for inspection shall be made 24 hrs. in advance-phone 259-881 5. � <br /> 2. AI���work sha�l�.ie performed in accordance wdh this permit and current City of Everett Design and Construdion <br /> Standards and Specifications. <br /> 3. C[dl Lowtion Underground Service 48 hrs. before you di� TOLL FREE NUMBER 1•800•424•5555. � <br /> � / / <br /> �}, C /ea.c-yn/ C�+�d �f vrc 'nrI OY!� � //��Gi/ /�rCiji-e�L <br /> � /�,,,s. � � � , � i 0 <br /> f � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby egre?s to hold and save harm- <br /> less the City �f Everett from any and all claims for damages, costs, <br /> / expenses, or causes of action that may arise because of installalion <br /> ��� �/Z „/�� — and mainienance ol the improvement or other right-of�way use herero <br /> �]� •9Y <br /> � applieo for and (urther agrees tu remove ;ame upon notice from the <br /> i Appr�(9r,Con uc ion ^ D te City and to replace public property damaged thereby. <br /> iin �. <br />� ���� %li��_ 1��� / �� � <br /> FINAL INSPECTION Date � <br /> GE66�b 5 ^L � <br />� Approved a�Construct Signature ol Applicant '� T�Dale <br /> :verett PURLIC WORKS DEPART�IENT WORK AUTHORIZED BY THIS PER�91T MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA 98207 8E DILIG[NTL� PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TfiIS <br /> PROJECT OVER 90 DAYS DURATION. <br />