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�8te� `/`(�,! , <br /> /'y�, 6 D ~ PubLC 1Vo�h!PBrmil• .. ..—_`-' ." <br /> � V <br /> App�icetion For aiaa�oaa�.. � <br /> PUBLIC VI/ORKS PERMIT FubTolelFeeFoe = <br /> , LaatROol Fee PaiG f <br /> Print or Type Only e,�,��,o�e a <br /> //iZ �filr 7r ' /- / yarbiii�� F4P�� ln�a � /�O//� /Te�N ��GFi � �/� <br /> Owner Mail�ng Atldress Ci� ip Phune <br /> '�r„Iri w ct-�r� �i�7f —/.�Rf(.._ c�hC�� .f�i,�fi / 4 �=vr��rf a y� �/� <br /> Applicant Mailing Address Ciry Zip Phone <br /> DescribeProposetlWork �if'nAinl �,Y7 .1lns�P- wyj,p✓1� ��ypn��! 'r /�j�7— /��pf n <br /> Prolect Adtlress�if known) 3(IT7� K��� __ � <br /> Attech lour(4)copies of plans lor proposed work- Jraw to scale and note the lollowing as applica6le: � <br /> • Properry Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposed structures on the lot • Show any proposetl gratling changes <br /> • Ezisting and proposed utilities • Show measuremenis � <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•$8�5. � <br /> 2. All work shall be performed in accordance with this permit and current Ciry ol Everett Design and Constructien <br /> Standards and Specifications. <br /> 3. Call Loration Underground Service 48 hrs. betore you dig.TOLL FREE NUMBER 1•B00•424-5555. � <br /> rl/BGiG Gclll.�'.�S' f�.P�'.✓%� .UUT .�E'qr/i.C�'p �//BG O <br /> � <br /> �y" � <br /> � <br /> O <br /> a <br /> ACKNO\YLEDGEMENT OF CONDITIONS <br /> The undersigred owner/applicant hereby agrees to hold and save harm� <br /> less Ihe Cily ol Everett irom any ar�d all claims for dsmages. costs. <br /> expenses, or causes ol action that may arise because ol installation <br /> and maintenance ol ihe improvement or other right•obway use hereto <br /> applied lor and further agrees b remove same upnn notice irom the <br /> Approved lor Construction Date Ciry and lo replace pu6lic pro erty damaged the;eby. <br /> FINAL INSPC• "ION Date U Z-� $ � <br /> Approved::s Conslructed Signa ure of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHItJ <br /> � 3200 CedarStreet 180 DAYS OF OATE PERMIT IS ISSUED ANG THEREr,FTEF IS TO <br /> Everett,WA 99201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259�8615 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DUfiATION. <br />