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- ---- --- - — __ <br /> - - - ---- - - - ____- - -- <br /> ,--. �.. <br /> Date�G Puni�c wor�s re�mn. i <br /> Application For Biag Den��• � i <br /> 'n�'_— <br /> PUBLIC WORKS PERMIT P�bhCW0ik5FC0 --- I <br /> To1G1 Fee 5 <br /> Less Rppl.Fee Pai� S � <br /> 9aiance�ue S I <br /> Pri�t or Type Only � <br /> I ��'• I ( vll�:� f)J� `�� � x i�v7 <br /> C.�P�ClOI ���,�/a / , »,. � . � _ � . ,,� ,� ., F-i�r�, n�� .�c�'�:.iUlo �5� �6_3�'D � I <br /> Owner � MailingAddress City � Zip Phone I <br /> /aoc/�D ,��uar.t:, c'DiG' �r�fe, l�c!' �l ['vPi�l/ yr�.�G .3 .3�/�-/��Z-`f <br /> 'qpplicant Mailing Address City Zip Phone <br /> i� �/ <br /> Describe ProPosed Work 'S�i /C/L�' Ldln-J� 14L �: L/l�J.?i����J tw T ��I�ar�jf(J� rJ1 �� i n �_ <br /> W <br /> Proiect Address(if known) ��t7 �(if�c n/�n llnr � <br /> Attach four(4� copies of plans tor proposed work• Draw to scale and note the following as applicable: � <br /> • Pruperty Lines • Centerline of street � <br /> • Outline and dimensions ot all ezisting and • Indicate North <br /> proposed structures on the lot • Show any proposed gcding changes <br /> • Existing antl proposed utilities • SYow measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDI110NS O ` <br /> 1.All cells for i�spection shall be made 24 hrs.in advanc3•phone 259•8810. � <br /> 2.Atl work shall be performed in accordance with this permit antl current City of Everett Design and Construction <br /> S�enda�ds and Specifications. <br /> 3.Cell Locet!on Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•500-424•$SSS. � <br /> O <br /> ?� �, t-,%;.._; -���,�( iT' ��c„ , �— <br /> _ ;.�,�� l �� ��(� O I <br /> � '�' �` ,J a <br /> ` � �_ :, , <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The unoersigned owner/apPlicaM hereby agrees to hold and save herm• <br /> " lecs Ihe Ci�y of Everett from any and all claims for damagea, costs, <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance of the impr„vement or Other righPol-way use hereto <br /> applied fnr and further agrees to remove same upon notice from the I <br /> Approved tor Conslruction Datr, City and tc replace public property damageA ihereby. <br /> FINAL INSPECTION Date <br /> � Approved as Cons�ructed Signature ol Applica�t Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED 4Y THIS PERMIT MUST BE STARTED WITNIN <br /> � tB0 DAYS OF DATE rERMIT IS iSSUED AND THEREAFTFR IS TO <br /> 3200 Cedar Street I <br /> Everett,WA 98201 BE DILIGENTLY PURSUEO TO COM'LETION. THIS PERMIT MAY BE <br /> Phone:259�0070 CA�CELLED BY THE CITY U?ON AN"STOPPAGE OF WORK ON THIS <br /> 1 ROJECT OVER 90 DAYS DURATIO��. <br />