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L_ np '7 , 7- // 7 <br /> Date�� � cwi��wo�xs�e�T��= _ <br /> q-� S�, <br /> eiae.o�o�.<_2L — <br /> Application For <br /> PU��I� VIIORKS PERMIT PubTalelFxeF�e 5 -- <br /> Less AOoI Fee Faitl S�— <br /> Balance Due $ <br /> Print or l'ypv Oniy <br /> �+ � r�5�=�1Y� I�l;� �r�rn��u � r-���F_Ti �w �g� i .?..���� - i �� <br /> Owner Mailin�Address � Ciry Zip Phone <br /> ��{���� Phone <br /> Applicant Mailing Address City Zip <br /> D=Scribe ProFosed Work <br /> �F la i�l �•P��..�C�� < < ' _r�T-.L /��I�'k �3 I ;�'1�E"rrt <br /> �� , i -� — <br /> � ,�� <br /> -- - W <br /> —-- Z92S- 9� /.3�'�sf � : <br /> Project Address(if known) — <br /> Attach four(4)copies of plans tor proposed work- Draw to scale and nole lhe following as applicable: �A ! <br /> • Properry Lines , • Centerline of street �� ■ � <br /> • Indicate Norih d� � <br /> • OuUinn and dimensions of all existing and j <br /> proposed structures on the IoY • Show any proposed grading chanc�es <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LIME A <br /> PEHMIT CONDITIONS � <br /> 1. All calls for inspection shall be rnade 24 hrs. in advance-phone 259•881 5. � ' <br /> 2. All work shall be perform�d in accordance with this permit and current City of Everett Design and�onstruction <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 48 hrs. betore you dig.TOLL FREE NUNIBER 1-800•424•5555. � <br /> 0 <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everelt from any and all claims for damages, costs, <br /> expenses, or causes of action ihat may arise bec2use ot installation <br /> �' / i � �% and maintenance of the improvemenl or olher ri9ht-ohway use nereto <br /> ��f OZ�� 1-1-" � �-�/�7 applied for and idrther agrees to remove same upon nolice from the <br /> Approved(or Construc � n / Date City and to replace public properry damaged ihereby. <br /> ��� �-�6� �/ �' �� —�� <br /> Date � / �j <br /> FINAL INSPEC ION Date <br /> Approved as Cons!rucieU Signature ot Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTEG WITHIN <br /> everett PUBLIC WORKS DEPARTMENT �p0 DAYS OF DATE PEfiMIT IS ISSUFD AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY B[ <br /> Everett,WA 98201 CANCELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Fhone: 259•E32`r .S1JSQG� PROJECT OVER 90 DAYS DURATION. <br />