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- ---- <br /> --. - - - - - - � <br /> -- ._.�__ _ __ . ___ _. � <br /> �/�/��jyD � � / � � <br /> Date'/T�T-' ; PULLC'rYorkS Pe77���. � I <br /> Application For d,:v Cep� + _JJ�/ __ ' <br /> ��JBLIC WORKS �'ERMIT Publ¢YloGSFce -- i <br /> Total Fee S--- I <br /> Less AoW�Fee Pa�:: �._—.�-- <br /> Balance�ue S___ . <br /> Print or Type Only -- <br /> AJ�_en�o� inr�a BI�U� -[��'' ve SL Euerrtt 982�k 347-��91�8 <br /> Own r Mailing Address City Iip Fhone <br /> L=ver�tt ii)� AK . �nr_ _ �SaOfo C�Prorer �v�e�J �0.� ,�53-7/l0/ _ <br /> Applicant nlailing Address --� Cdy Zip Phone <br /> Describe ProP�-Pd Work �(��� 1� �(111 " (�� 5 T �Q• �. <br /> — — ---- - — I <br /> - _ WI <br /> Projed Address(if known� -- � <br /> Attach four(4)copies of plans lor proposed work- Draw to scale and nole the following as applicable: � <br /> • Property Lines • Cenlerline ot siree� � <br /> • Outline and dimensions of all existing and • Indicate Nor�h <br /> proposed shuctures onthelot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1.All calls(or inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> ��f���. ((fd� /�:i ��.-.r.� f /��7! �¢.f.'c,; �� � �. <br /> { <br /> �:�,-�!>�:.�-�� �.. <br /> �-/7-..�� � <br /> Oq <br /> idw <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> The w,�:arsigned owner/appliwnt herr,by agrees to hold and save harm- <br /> less the City ol Everett from any and all claims for damages. costs, <br /> expenses. or causes of action ihat may drise because of installaGon <br /> ant maintenance o! the improvement or o�her ri,yht�ol-way use hereto <br /> applied icr and furihei agrees to remove same upon nuiice trom ihe <br /> Approved for Construction Date Ciry and to replace Uublic Rroperty damaged thereby. <br /> FINAL INSPECTION Date - — <br /> Approved as Constructed Signature ol Applicant Date <br /> WORK AUTHURIZED BY THIS PERMIT MUST Bt STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 780 �AYS OF DATE PERMIT IS ISSUED AND THEhCAFT[R �S 70 <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERM;i ,NAY BE <br /> Everett,WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK(�i!THIS <br /> Phone:259-8810 PI70JEf,T OVER 90�AYS DURATION. <br /> — � <br />