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Date_=LLJ-ZS � P�oi��wo,ksPe,mnp U7 //S <br /> l� � <br /> Application For BItlO Ocpt.a_�,����. <br /> PUBLIC WOFiKS PERMIT P°°Pw�ks�c� �� �n , <br /> Tola1 Fee S I <br /> Le.sApP��Fee Paid 5 <br /> Print or Typs Only e,m�«o�� S 2U=° I <br /> �- <br /> ,� � ' <br /> ,��=�-I'� f��;;�_ . 14,'��l I'���7,��'�d,l'll.r-l- �a ��1`�:� ��aC 1 ��=�.�- I rE��, I <br /> Owner Mailing Address � City Zip Phone I <br /> -���!'117 �+� �� <br /> ApP��cant Mailing Address Cily Zip Phone �. <br /> Describe Proppsed Work ������,� �J � �� ) f-� C/t� ` (��c)I ( ' �-�% 1 �` ' I <br /> ProjectAddress(ifknown) �/�:� �� � .� — /..3�--��.5� � � <br /> � <br /> Atlach lour(4) copies of plans(or proposed work- Draw to scale and note the following as applicable: � <br /> e Property Lines • Centerline o(street ♦� <br /> • Outline and dimensions of all existiny and • Indicate North 1�� <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities i Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PE9MIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phoae 259•881 S. � <br /> 2. All v.�ork shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Slandards and Specitications. ��. <br /> 3. Call Location Underground Service 48 hrs. bctore you dic�.TOLL FkEE NUMBER 1-800•424-5555. � ��I <br /> � I <br /> ) <br /> I <br /> � I <br /> � <br /> � I <br /> � ; <br /> —�,/ ACKNOINLEDG[M[NT OF CONDITIONS <br /> J�� The undersi9ned o;+ner/applican�hereby agrees�o hold and save harm- <br /> less Ihe Cily of Everelt hom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> �/� ! � � � and maintenance of the im rovement or other ri ht-of-wa use hereto <br /> � ������ "�'�`��L ��� � '�� applied lor and further agrees lo remove same upon notice from thc <br /> Approved for Const �ction/f Date City and to replace public property damaged thereby. <br /> ✓�L��� �O�`f� � `, I... <br /> FWAL INSPECTION Dafe /�/^�•'�`� ��- '4i'�t� /� " <br /> Approved as Constructed Signature of Applicant Date, <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITf�IiN <br /> � 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98207 BE CILIGENTLY PURSUED TO COMPLETION. TIIIS PGRlvill MAl' BE <br /> Phone: 259-6s_�- ^-yi��i; CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORI<ON THIS <br /> " PROJ[Cf�OV[R 90 DAYS DURATION. <br />