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��.....�,..�3*Tr�?:?�„'Yr,;JEk'x.�;^`�-`�:�.�� .. , .. <br /> �., ,. <br /> . ` ---�.�.��� <br /> oate �� �lG ' ^ <br /> ` �� PuDlic Works Parmit a <br /> ApplicationFor _ em9.oeo�-+— �7C/ ZrJ�� <br /> ! <br /> PUBLIC WORKS PEI�MIT P�D�,�W��M.Fea <br /> Totei Fee S <br /> Less AOP�Fee PaiG S <br /> Print or Type Only Balance Due s_ <br /> �li�� '� i�V61 �� �X /�/�/°.�/ iYfidan ! 1� <br /> � Owner MaiFine Address City Zip Phone <br /> Applicant MailingAAdiess City Zip Phone <br /> 1 <br /> DescdbeProposedWork ll'_ �G�A(CJ��f�,OA�� — A � i�r1 r.li�i�/� (�a�y(/ G/V <br /> Project Addresa(if known) 7 L�1/(�/ //�/�y/ �j � � <br /> Attach four(4)copies of plans for proposed work- Draw to scnie and note t e fo�lowing as applicable: �� � <br /> • Property Lines • Centerline of sfreet � <br /> • Oulline antl dimensions of all existing and • Indicate North � <br /> proposed structures on the lot ' • Show any proposed gratling changes <br /> • Exfating and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THI5 LINE � <br /> PERMIT CONDITIONS O <br /> 1.All celln for inspection shell be made 24 hrs.in advance-phone 259•8810. <br /> � 2.All work ahall be peAamed in accordence with this permit and current City of Everett Design and Consiructlon ' <br /> Standards and Specifications. <br /> 3.Call Location Underground Servica 48 hra before you dig.TOLL FREE NUMBER 1-$00�4245555. <br /> � � <br /> �v�a l.daz/�. ��i•u f /�-1�,���.,,.� TC*z O <br /> �: .TI. <br /> �..����_ I-- <br /> � -� -sd � <br /> O ; <br /> a ; <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownei/applicant hereby agrees to hold and save harm- <br /> less the City of Everett trom any and all claims for damages. costa <br /> expenses, or causes of action that may a�ise because of installation <br /> and maintenance of the improvement or other right•oi•way use hereto <br /> Approved for Construclion Date applied for and fvrther agrees to remove same upon notice from lhe <br /> City and to replace public property damaged the�eby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> everett Pl;BLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHiN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTFR IS TO <br /> EveretG WA88201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMI7 MAY BE <br /> � Phone:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />