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�5���. Y.L\�'f�AC�A�s��.:�a�+�i <br /> '}'/ _ /� 7 <br /> � � �n ..'j �� i•,oi,:�.;�. : ' <br /> Date`7.1_L_u � .�-7 � j -,�'F <br /> m Oept o _ ��:--- <br /> Appfication For ������" �.�17� <br /> PUBLiC WORKS P�RMIT '"°T��aF�aFe° S <br /> LessAppl.FeePaiO S ��� <br /> Balance Oue $ <br /> Print or Type Only <br /> �`� ' -��"�,�� r� h�?'I(4�J�!L,� Gt �� ' :l l `�-; (;1. P s�-I l � <br /> Uwrer � Mailing Aridress Q G�ty Z��' <br /> _� _ zi phone <br /> Applicant '„ailing Addresc C��1' � <br /> 1<': L f'7� C 1 /� l,C�� `1 — <br /> Deacribe Preposed Work �•���� ����� <br /> - — �� <br /> _— — _ � <br /> prol�ct Address(il known) <br /> 2�i� A � R - i.���s-t � <br /> �� <br /> Atlach lour(4)copies of plans tor proposed work- Draw to scale and note the tollowiny as applicable: � <br /> • Property Lines . • Centerline of street <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lol • Show any propcsed grading changes � � <br /> • Existing and proposed utilities i Show measuremv,nts <br /> DO NOT WRITE BELOW fHIS LINE O <br /> PERMI7 CONDITIONS � �. <br /> 1. All calls tor inspection shall be made 24 hrs. in advance- phone 259-881 5. <br /> 2. All work shall be pertormed in accordar.ce with this permit and current City of Everett Design and Construction I <br /> Standards and Specifications. <br /> 3. Call Location Undergr��und Service 48 hrs. betore you dig.TOLL FREE NUMBER 1•SOO•424-5555. � ;I <br /> O <br /> �� <br /> �A� <br /> c� <br /> � <br /> �o <br /> I <br /> I <br /> 1CKtJOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm- '. <br /> '- I�ss the City of Everett from any and all claims for damages, wsts, ; <br /> eapenses, or causes of action that may arise because of installation �. <br /> �/� �i,_ 7 and mainte^ance of the improvement or ether r�ght�o4v.�ay use hereto <br /> ���j,�Ji�^-�7�� 7'-ai'" �I yppiied for and further agrees to remove same upon notice from the � <br /> Approved for CenSruc�� i Date City and to replace public property damaged thereby. ' <br /> . l% _ �'aG�1 s/ /y� <br /> Date .�`=-� �� Date <br /> FINAL INSPECTION uignature of P�pplicant <br /> Approved as Constructed <br /> WORK AUTH ORIZED BY THIS PERMIT MUST BE STARTED WITHI <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS O F DATE PERN,IT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENI-LY PUPSUED TO COMPL2TION.TH!S FERN{T MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phcne:259-� $$� PROJECT OVER 90 DAYS DURATION. <br />