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__ , r� r� � <br /> Qate�� ' PUUtic Work�PermB• <br /> Appliwtlon For amu odw..� 7�(��— <br /> PUBLIC WORKS PERMIT P°��'cWmk�Fee — <br /> Tot�l Fea S � <br /> Les�Appl Fce P�id f <br /> B�bnce Dun f <br /> Print cr Type Gnly <br /> f�on. A/:n �,n� Nn /'Y1X �� 7 G�.��.(A `7�i',�X/� <br /> Ownar MaiNng ACdress l:ity 2ip Phone <br /> �,�..�ml.��/ �sr�s -/9� �i�r :r� � .�{ t��� 9R�v,� 3.��-y�-- <br /> A p icant Mailing Address City Zip Phone <br /> DeecNbePropcsedWork _ TQ�1�T!�jP�✓P�t�� �H� i'YlX�`� <br /> ��� <br /> _ � <br /> Projed/,dd�eas(il known) � <br /> Allech four(4)copies ol ptans for proposed work•Drew to scale and note the IoliowinB as applicable� � <br /> • Property Lines • Genterline of sireet � <br /> • Qutline and dimensiens ol all ezisting and • Intlicete North <br /> proposed niruclures on the lot • Show any proposed grntling changes <br /> � • Existinp end propoeed utilities • Show measuren�cats � <br /> DO NOT WflITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t. All celis for inepection shell be mede 24 hrs.in advance- phone 2S9$8�S. I <br /> 2. All work shall be Fertormed in accordance with ihis permil end current City oi Eere!t Design und Construction � i� <br /> Stendards and Specifications. <br /> � 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE KUM0IER 1•800•424•SSSFi. �� I <br /> / ��� � � <br /> 14�-�-Y �F��- ��� / " 0 I <br /> H <br /> �/c`7 �"�c�C �. �p�;rs `'F.r.�>iT .�'F�G �i'F4 � <br /> � 3/�? O <br /> r� � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/apGlicant hereby agrees b hold and save hnrm- <br /> --� — less ihe City of Everett irom any and all claims for damages, cosis, I <br /> expenses. o� causes of action Ihat may ari,e because o1 installation <br /> and maintenance ol the improvement or other righl-ol-way use hereto i <br /> — applied lo� and lurlher agrees to remove same upon nolice from Ihe <br /> � ApproveG for Construction Date City and to replace public proper mageC thereby. � <br /> FINAL INSPEGTION Date � ���/� ��~�— � � � <br /> Appmved as Consiructed Si9nature of Appi�ca t Date <br /> 0 everett PU�LIC WORKS DEPARTMEN�i WORK AUTHORIZED 8Y TNIS PERMIT MUST BE STARTED WIT41N <br /> 780 DAYS OF DP(E PERMIT IS 1SSUED AND THEREAFTER IS TO � <br /> 3200 Cedar Street BE DILIGENTLY PURSUED TO Gi�MPLETION.7NIS F'ERMIT MAY BE � <br /> Everett.WA 96201 CANCELLED BY T+iE CI?V UPON ANY STOPPAGE OF WOHK ON i HIS <br /> Pho�e: 259-8815 PROJEGT OVER 90 DAY�DURATION. <br />