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� <br /> _ _ - -- ____ _ _ <br /> rDate ^��-�� PUCIicWorkePermil• �A z�� ' <br /> Applicatlon For eiep.Dao�• <br /> P@JBLIC WORKS PERMIT P��LCWorksfeu l <br /> Tahl Fee S �U'�`/ <br /> � Leae Aoc1 Po.paiE S <br /> Print or Type Only 6alance0ue S �� <br /> ,� 707�5 <br /> , �. 1- <br /> , � ►IoRe�<<srt Sf�v�Nt;C IZ3(vo � �t�cac�r� wlt,yE �E �1��r �'8►zs 3(�`1-o3oa <br /> Owner MailinpAddress City Zip Phone <br /> �!Zes� C-�s�r. C,�� iw� - 4-i4�'� Srsw�l�� d �7Mw.�u� ��3b 77S s�2� <br /> � �� „F,F,qp�icant�C L���� MailingAddress City Zip Phone <br /> C7+t-+�^� n, 1��n <br /> Describe Proposed Work "� ��� ��� �%��S�J� �U t l_�� � �lv� � T1UiV O"� <br /> �3�1 <br /> .�1_ aUrt -v�—F►'rci ►_�Tti <br /> ProJect Address(if known) �� � 'L V ��' Y ^ CV E� � � <br /> h <br /> Attach four{4)copies of plans for proposed work- Draw to scale and note lhe following as applicable: �� <br /> C Pioperty Lines • Cenlerline ol slreet � <br /> • Uulline and dimensians of all exisling a�d • Indicale North <br /> proposed structures on the lot • Show any proposed grading chanaes <br /> O Existing and proposed utilities • Show measurernents � <br /> � DO NOT WRITE BELOW THIS!_IP'E � <br /> �ERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259-881 5. � <br /> 2 All work shall be performed in accordance wilh this permit and current Ciry of Everett Design and Construction <br /> Standards snd Specifications. <br /> 3. Call Localion Underground Service 48 hrs. before you dig.TOiI FREE NUMBER 1•800•424-5555. � <br /> A$ �G'Y /�7LC2hS ��7vG� y•'� '�� � <br /> � <br /> S Y! <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/appticant hereby agrees to hold and save harm- <br /> tess the City of Everett Iwm any snd .:r claims lor damages, cosls, <br /> / � expen�=s, or cnusec of action that may arise 4ecause ol installation <br /> �./j /,� ,/ and maintenanc± o! ihe improvemenl or other righbol-way use hereto <br /> � ry'� <<T � }� applied lor and further agrees to remove same upon notice irom the <br /> Approve for Construction � Date Cily and to replace F�uhlic property damaged thereby. <br /> -���� �%�G-��_ � � ' � <br /> F L NSPEC ION ' Date VJ � �� Date <br /> Approve[1 as ConsVucted Sgnature ol A Iicanl <br /> evrre:: PUBL�C WORKS QE{. ITMENT WOfiK AUTHOFIZE�J BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Strect 180 DA"S OF �NTE PERMIT IS ISSUED AND THEREAFTEH IS TO <br /> Everett,WA 98201 I BE DILIGENTLY FU?9UED TO COMPLETION. THIS PERMIT MAV BE <br /> � Phone' 25�-8815 CANCELLED BY THf_ CITY UPON ANY STOPPAGE OF WORf<ON THIS <br /> PROJECT OVER 50 DAYS DUFIA710N. <br /> � .,� <br />