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� c� 3`' --` --' �'(—.387 <br /> Date��� r�n���wo�k�P�„m��� <br /> Application For om� 000i.+—c���/ �iC�� <br /> PUBLIC WORKS PERMl� PublicWnrksFec <br /> Tolal Fee $ <br /> LecsAppl.Fec Paitl $ <br /> Print or Type Only e��a��e o�� S �D� <br /> _ 7� �9a� ����! A�.� i1✓F_ /-��I� �-(-�na l��0�2 � (a5 9- G,I y� <br /> nwner Mail:ng Address Cily Zip Pho e <br /> S„�_ <br /> Applicant Mailing Address City Zip Phone <br /> Describe Praposed Work ��((! t J���1�/�� l�`_r /1 f/ ^ P�L� <br /> ProjectAddress�ifknown) . �Z��(o — � '���?, SE � <br /> IIAttach four(4)ropies of plans for proposed work- Draw to scale and nole the lollnwirg as npplicable: � <br /> E • Property Lines • Centerline o(sireet <br /> 4 • Outline and dimensions of all existing and • Indica�e North � <br /> 6 proposed structures on tl:e lot • Show any proFosed grading changes <br /> f • Existing and proposed utilities • Show measuremenis � <br />�` DO NOT WRITE BELOW THI�IN�L�' <br /> I �� PERMIT CONDITIONS <br /> 1. All calls for inspection stiall�,:made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City ol Everett Design and Construction <br /> Standards and Specitications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FFEE NUMBER 1•800•E%4•555[i. � , <br /> �. �Do�S�-�:.�-� CPa c,�L 5 w� I�i.v�1 , �� <br /> 5, VSC S�R-� ��� �-''�C-2_ (=02 C�UwrlSPou�i"s . O <br /> ��/� <br /> V♦ <br /> n � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less ihe City of f.verett Irom any and all claims tor damages, costs, <br /> �����— �//�� expenses, or causes of action that may arise because ol instaPation <br /> and maintenance of ihe improvement or olher right-of-way use hereto <br /> Approved for Consh� n Date applied for and further agrees to remove same upon notir,�e from ine <br /> --� <br /> City and to replace public properry damaged thereby. <br /> FINAL INSPEG, 0 � '��� <br /> Dzte �St�,�_ 'y'.�� �' � �`�/ �A � <br /> Approved as C:,nstructed 5ignature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WOfiK AUTHORIZED BY THIS MIT MUST BE STARTED INITNIN <br /> � 3200 Cedar Sl�eet 180 DAYS OF DATE PER�.11T IS ISSUED AND THEREAFTGR IS TO <br /> Everelt,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br /> Phone: 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> � <br />