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�►..-..�,,.r..s.,.�.-__... _ ---- — --- - - � _ <br /> —� - - <br /> G � <br /> �e�e,3,� �, <br /> / PuGI¢Works Parmll• <br /> Applkation For Biop.oepi.e � <br /> PUBLIC WORKS PERMIT P�����W�,�.fe� <br /> ToblFee s <br /> , Leta�ppl.Fee PNE f <br /> Print or Type Only 6el�n<eDue s <br /> �'n:�,"�P.nr� l�,cn,'�n0 1�0' �x /OG 7 E �,�.� Q�P.dlL6 �-S� z�1J�' <br /> Owner Ma�Hng Address City Z�p Phone � <br /> .�/P�.1/�1.d /�rrd c�lM c�.rM �/ �Nc. <br /> P��- �Sl� �,,,��,� ���ay� as4 oi� <br /> App rcant Mailmg Adtlress Cdy Zip Phone <br /> Deacribe Proposed Work (�t��g��� �y��� �[ �,,, A-� //¢-/� <br /> c <br /> Project AdCress(if known) � � <br /> Attach lour iQ)copies o� plans tor proposed work- Draw to scale and note the fullowing as appli�able: � <br /> • Property Lines • Centerlin�ol street � <br /> • Outline and Aimensions of atl exisling and • Indicate'Vorth <br /> proposed atructutes on the lot • Show any proposed grading changes <br /> • Ezisting and proposed utilities • Show measurements � � <br /> DO NOT WRITE BELOW THIS L1NE <br /> PEFMIT CONDI710NS O <br /> 1. All calls lor inspection shall be made 24 hrs. in aCvance•phone 259•g815. � <br /> 2 .411 worh Shall be pertormed in accordance with this permit antl current City of Everett Design and Construction <br /> StandarCs end Specificatlons <br /> 3. Caii Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> /�i�0 ��ii.�i'��C ��v�1c' �-"'��n.,�=- ���4� ��'c`_� <br /> 3 - .�/ - fTb O <br /> ,�� � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> _ The undersigned owner/applicant hereby agrees to hold antl save harm- <br /> less the City of Everet� irom any antl all claims for damages. costs, <br /> expenses, or causes ot action that may arise because of installation <br /> and maintenance of ihe improvement or other rigM-oFway use herefo <br /> Approved for Consirudion ��-- — applied lor antl furiher agrees lo remove same upon notice Irom the <br /> Da��e City and to replace public property damaged �hereby. <br /> FINAL INSPECTION Date <br /> App�oved as Constructed Signature of Applicant Dale <br /> everett PUBLIC WORKS DEPARTMENT �'ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAfTER IS TO <br /> Everett,WA 98201 BE D�LIG[NTLV PURSUED TO COMPLETIO�. THIS PERMIT MAY BE <br /> Phone:259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> I PFOJECT OVER 90 DAYS DURATION. <br />