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i: <br /> � <br /> � <br /> � <br /> , <br /> � <br /> r� � Public WorF9 Pnrmil i <br /> Date�� � � <br /> ppplication For Bi�g.Depi.• —�a� 7 ��_ <br /> PUBLIC WORK� PERMIT P°°4oWFee`�° � -- <br /> Less/nol Fee PaiJ $ <br /> � Balance�ue $ <br /> Print or Type Only <br /> � <br /> � $o%�n 54n�i G✓ B�niPPn LU(T�/ r�ninl� ��f�D � 353-13�i3 <br /> '. ��Owner Madmg ddress City Zip Phone <br /> pplicant Mailing Address City Lp Phone <br /> � DescribeProposedWork �L�J'���p� p� S�il �78� /�P.J`IhuMi[f <br /> � I W <br /> Project Address�il knowrl — � � � vr��A rt. a/Q 1/ � <br /> Attach lour(4) copies of plans for proposed work• Dravi to scale and note the lollowing as apnlicable: � <br /> • Property Lines • Cen�erline ol street � <br /> • Outline anA dimensions ol a'i axisting and • Indicate North <br /> proposed struclures on the lol • Show any proposed gradin9 changes <br /> . • Existing and proposed utililies • Show measurements � <br /> '. DO IVOT WRITE BELOW THIS LINE O <br /> ' PERMIT CONDITIONS . <br /> � 1.All calls for inspection shall be made 24 hrs.in advance•phone 259-8810. � <br /> • 2.All work shall be pertormed in accordance with this permit and cu«ent City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 46 hrs.before you dig.TQLL FREE NUMBER 1•800•424•5555. � <br /> �J I',�,e�n�� ���i��C�°�� ����!',d'�-�':- � <br /> Y? , -N/ � <br /> Vi <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ow;ier/applicant hereby agrees to hold and save harm- <br /> less the Cily ol Everetl Irom any and all claims for damages. costs. <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance ol the improvement or olher right-of•way use hereto <br /> applied lor and further agrees to remove same upon notice irom lhe <br /> Approved tor Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date — <br /> Approved as Constructed Signature o�Applicanl Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evere[t PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED ANu THEREAFTEFi IS 70 <br /> � 3200CedarStreel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMI7 MAY 8E <br /> Everett,WA 98201 CAIJCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br /> I <br /> i <br /> �I <br />