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Date � - • � "- �`I'�- �d <br /> Pu�Lc Warks Parmi a <br /> Application For aioo�o�c�._ ._ <br /> PUBUC WORKS PERMIT Pu4licWarksFee - <br /> iotn�Fee g ._. <br /> Less A00��Fee PaiJ S_�__ <br /> Balanco Due � <br /> Print or Type Only <br /> �\ <br /> �� � �, �e � �si - ��Y� <br /> OH�ner NaJing Address City Zip Phone <br /> �J�'�tiC <br /> Applicanl �Aailing Address City Zip Phone <br /> � <br /> Describe Proposed Work — �!"����� <br /> Project Address(if known) � �ZU/��%�����iE'_ .SE_ � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines N Centerline o�street � <br /> • Outlir.e and dimension;of ell existing and • Indicate North <br /> proposed sVuc�ures on the lot O Show any pwp•�sed grading changes <br /> • Existing and propcsed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PEF�,:IT CONDITIONS <br /> � t. All calls(or inspection shall be made 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 Consiruction <br /> Standards snd Specitica�ions. <br /> 3. Call Location Underground Service 48 hrs. 5efore you diy.TOLL FREE NUMBER 1•800•424•5555. � <br /> y .�c',o���� .�-✓v v ��,Q _ — <br /> , 9 � ,�c�-� �'�i�3 �ra-r�Fi�, �- s�J � <br /> �Exc'E�i C,E',y�,C�n s� � GS'i,^�E� �v.ef.�' a�/ �(JOP_T// <br /> �c,✓v .�;� ,f�T 9c,��an� r�o�✓E� <br /> � , C�F'r?E� LoT So f,�S NOT To li�?F?CT Sv/2,PDv�U9N� ��/� <br /> LUT ��rliT// �.'9i.�/Gc/.�E.e it�'�/Ofj�' �Y� <br /> �o. CONi+/�ci ��„�s,���,.�T� �� �,�F�,����� sys��. O <br /> .� r�� = '�,,. �;� —�s �� �� �� �, G`�`� 0� <br /> �- ��f-6� � /�.�o le-t,�,P�- �.� l,o,,,�e.� +� � l�,,�.� . <br /> � ��'�. ��.�.,,.. _�,� iC�:�,,,,�-�' �Zz ir�,sr��� " �� <br /> The undarsigned owne/applicant ereby agrees�o hold and save harm- <br /> less ihe Ci�y of Everett from any and all claims lor damages, costs. <br />� r �' expenses, or causes uf action that may arise because of insfallation <br /> ��� ��.3 / ��y�6 and maintenance of ihe improvement or olher right�ol-way use her�to <br /> u� <br /> applied tor and further agrees to remove same upon notice Irom the <br /> Approved lor Co ruction '� ��a!e City and to replace public property damac�ed thereby. <br /> - ��1�� ' �� <br /> FINALWSPECTION � Date ��-��" � � � �.--�. � S �" <br /> Approved as Constructed Si�nature ol Ap�f nt � Datu <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHOFI2ED 8Y THIS P RMIT MUST B STARTED WITHIN <br /> � 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett, WA 98201 BE DILIG[NTLY PURSUED TO COMPLETIOtJ. THIS PERMIT MAY BE <br /> Phone: 25°-8875 CANCE�LED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVEH 90 DAYS DURATION. <br />