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� � p Pubbc Wo�ks Permil v <br /> Date—� C>� <br /> ema o�n�..— <br /> Application For <br /> PUBLIC WORKS PERMIT PubLCWaiksFeo 5 — <br /> To�al Fee <br /> Le55 Appt Fee PaiA S <br /> Balance Duc $ <br /> Print or Type Only <br /> �� I � �P C� �t-���el( II�/ P�'ne 5f E=�-e��7` q�2��� �S�--SG��[r <br /> OHner MailmgAddress City Zip Phone <br /> �3 � l � C o-�-�i�� �( !�� r Pi ne 5f ,E�e�-e`H" �'��� ��a�54��� <br /> ApNicant MailingAddress City Lp Phone <br /> Describe Propased Work f mL�V e lT f G15� �a✓�� 1:'e �IQ C � <br /> � -} �� ;Jc, ve � , yn U� b,� G��tc� �1 �� Gr�, "c� � <br /> < <br /> W <br /> Prolecl� ddress(if known) H <br /> Altach f<ur(4) copies ol plans lor proposed work- Draw to scala and note the following as applicable: � <br /> • Property Lines • Centerline of slreet <br /> • OuUine and dimensions of all exisling and • Indicate Norih <br /> propesed structures on the lot • Show any proposed grading chan�es <br /> • Existing and proposed utilities • Show measuremen�s � <br /> '�� DO NOT WRITE BELOW THIS LINE QJ , <br /> PERMITCONDITIONS u t � � � O <br /> � 1.All calis for 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 Consir ipn � <br /> Standards and Specifications. � � � i <br /> 3.Call Location Underground Service 48 hrs.be(ore you dig.TOLL FREE NUM�ER 1=800•424•5555. nt� � <br /> b <br /> � - -- o°li �f � O <br /> , �1 <br /> � - - � --� �,- - -c� __ _ _� c�, <br /> _ - - - - ,, n r-n- � ~� r � �� - - - � '1 1 � � , 1� <br /> �'I � ii� � V ' � r <br /> i <br /> 1 � �� // � � 1 � � Jr� GJ � � � / � / � I <br /> I � ���� � ' <br /> y �� �i i� U i (� 1 1 1 � <br /> , <br /> � <br /> ._ , ` � 0. <br /> ,� � ' <br /> � , �� � <br /> � �. .� �,�?��� f� � , .� _ �. ,- <br /> ��, a°�v iil / ,�� i bi� � I ( <br /> i�� ;� , <br /> //�/y 'i� —�l N ACKNOWLEDGEMENTOFCONDITIONS <br /> 1 'C� 'l o The undersigned owner/applicant hereby agrees to hold and save harm- <br /> i � <br /> '� less ihe C ly ot Everelt from any and alt claims for damages, cosls, <br /> / I ��('� !1� �'�7 � j�, ezpenses, or causes ol action that may arise because of installalion , <br /> �/ 1 � � �. and maintenance ol ihe improvement or other riyht-of-way use he�elo <br /> � �` i applied for and further agrees to remove same upon nolice frum the <br /> Approved or Construction \ � / Dale City and In replace public properry damaged thereby. <br /> �� 1�� �q�� ., n\ G . �_p /,r? � <br /> �---�i !� Date �L���L-Cn-.+7 u� C .� ,,... . D <br /> FINAL IN iPECTION 1 �" ' � �4 � Signature ol Aoplicant ate <br /> Approved as Constructed \ � �V - � <br /> y� '\ i WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evereti I PUBLIG � ORK`DEPAIiYMENT �, " � 1g0 DAYS OF DATE PE9MIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 darStreet BE DILIGFNTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Ever�l.WA98207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF\NORK ON THIS <br /> Phone�.259�8810 PROJECT OVER 90 DAYS DURATION. <br />