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�dte%�/o " O ' Pu�Lc Wo�ksPormil M y0- 5�69 / <br /> Application For ema.oeo�.r <br /> PUBLIC WORKS PERMIT P�o���W��k,Faa <br /> Talal Foe � <br /> Less AOnI.Fee Paid S <br /> Print or Type Only 8,���=oo�a s �S�-� <br /> �OsLi..�ofvn/�v�ua! � BS/9�"�/ervreen/.�Jav �/e�e�7` 98208 `�G/- �'// 7 <br /> O�JI(er Mailing Adtlress�" • Gity 2ip Phone <br /> Thn.,-,2s E. To.�es <br /> Applicant Mailing Address City Zip Pl��one <br /> Dascribe Pioposed Work �C�nadt t�rds�i or�c� O�e •�rit �i•oi�� <br /> G�a«.-, f !ot .��,rf to 60.,,E- <br /> W <br /> Project Address 1if known) 8-S/9 - Ever r •�7 GtJtt� � <br /> Attach four(4) copies o(plans lor proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Cente�line of street � <br /> • Outline and dimensions of all existin� and • Indicate North <br /> proposed slructures on ihe lot • Show any proposed grading changes <br /> • Existing and proposed utili�ies • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit and current City ol Everett Design and Construction <br /> Standards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424-5555. � <br /> � ,jnS�c,/! 4�j/ �JecQS.tnr+s/ fL'�,�a�..ar3/ P�"oJ'inh Can�iri( O <br /> 4s D�ir-ecfec� hy f�� �v.�il�� C�/vr.E.r /n.r�eC>oi-, <br /> S, /�/O�i^v6i� o�' !'ornPacl:on �ui7��ii:, • fhe a�r.�oli.�es- ~ <br /> O�' �a�9e �(rce s ♦A <br /> \/♦ <br /> �, �LJee�` �s�i�/, f�vGli� lvo�,�r /n,rpe��o�- f o��f2r�nin C O <br /> T/�S �o lie S4//eo� �2�or� ,de�i�.���� �llOr�.. � <br /> ��c� rt �//82Z <br /> ACKNOWLEDGEMENT Of CONDITIONS <br /> The undersigned owner/applicant hareby agrees to hold and save harm� <br /> less Ihe Gly of Everett Irom any and all claims for tlemages. cosls, <br /> expenses, or causes of action ihat may arise becacse of installation <br /> c�j��0a�_ /Q�B�O and maintenance of the improvement or oiher right-o�•way use hereto <br /> � applied for and turther a9rees to remove same upon notice irom the <br /> Approve r�Cor,r.uuction . Da�e Cily and to replace public property damaged thereby. <br /> i�J / , � <br /> �L '�����'/� ' //, ��i ��/.��I ��� qr� <br /> FINAL INSPECTIOM�— //'� '/ " Date �ra�t-�vvwcl �UJ�9� lo <br /> Approved as Constructed " Signatur f Applicant Date <br /> eveiett PUBLIC WORKS DEPARTtvIENT WORK AUTHORIZF.D BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CetlarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8[ <br /> Phone:259�8810 C.INCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DUR�TION. <br />