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�{ /;% <br /> r• n[� �� ./{.. . 1 . Pu�IIc Works Permit� (l/ <br /> Dates ��' � � BIp9 Depl.x — <br /> ;';�i � l f <br /> qpplication For " <br /> pUgLIC WORKS PERMIT P°°'""'°`"=Fe 5 <br /> Tole1 Fee <br /> Less AOoI.Fec Paitl S <br /> palance Duc <br /> $ "��' �� <br /> Print or Type Only <br /> ,���•f7hl�f� /`� //L'.G� a' �GtSC'/,' �j �e��6y� Phone <br /> Owner <br /> Mailing Addr ss �itY Zip <br /> �/� _ 1 � 2 i''O �3� .�22,� �uP,����`'��n�-s127 2-���/oZ <br /> �'��C � City Zip Phone <br /> Ap('�icant Mailing A dress <br /> Describe Proposed Work ���� `�� �� <br /> W <br /> -- 32cs3 - / .� 7'' c6'u� �ZD/ �.,� <br /> Project Address(if known) <br /> � <br /> A�tach four(4) copies ot plans for proposed work- Draw to scale and note Ihe tollowing as applicable: � <br /> • Properry Lines tl Centerline of street <br /> • Indicate North <br /> • Outline and dimensions ot all existing and � Show any proposed grading changes <br /> proposed structures on the lot � Show measuremenls � <br /> • Existing and proposed utililies <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspeclion shall be made 24 hrs. in advance- phone 259•S81 5. <br /> 2. All work shall be perlormed in accordance with lhis permit and currenl Gly ot Everett Design and Construction <br /> Standards and Specifications. � <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800-424-5555. <br /> � <br /> � <br /> � <br /> � <br /> W <br /> ACKNOWLEDGEM°NT UF CONDITIONS <br /> The undersigned��wner/applicant hereby agrees to hold and save harm- <br /> less the City of Everetl from any and all claims for damages, costs, <br /> expPnses. or causes of aclion �hat may arise because of installation <br /> �' ard niaiNenance of lhe improvement or other right�ol-way use hereto <br /> .�—�� '���r���:�-'— G' ���� applied for and lurther agrees lo rr,move same upon notice Irom ihe <br /> Approved(or Construc�ion ���e City and to replace public prope�ty damagc�hereby. <br /> ����� �-��-�� /��, LL/ -" lttiC_" G''-��� <br /> FINACINSPECTION Date L `����� L- Date <br /> Approved as Constructed <br /> Signature of Applican� <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHI <br /> evem[t PUB�_IC WORI<S DEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. TNIS PERMIT nAAY BE <br /> Everetl.WA 98201 CANCELLFD BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phors: 253-0815 PROJECT OVER 90 DAYS GURATION. <br />