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�8te_///���`�� Pv�l¢Work�Permit• ` � —��v <br /> Applicatlon For e�oo.oep�.• <br /> PUBLIC WORK3 PERMIT P���icWorx�Fee <br /> Tolei Fee � <br /> lea�IOP�Fee PeiO S Uo <br /> Belence Due f � �`/%'P� <br /> Print or Type Only <br /> Nic�a�; T�r �3-.ta=d ��E.�F.r i�9_ 9g�o� � s.,�_sib/ <br /> Owner Mailing Address City Zip Phone <br /> CT E.36.�-�' a9i�r ���•i �v. 99zai �sB-9.3GG <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work ��a� 0�=� J%/��c✓.Q�.� L�JiT� TE'�,r�72�y.2// <br /> i <br /> FE�✓C.'.� �p �F'��o�7FC. SiO�e'FFf'O�T <br /> W <br /> Project Address(if known) `��� ' ����� ' — �vC• � <br /> Attach four(4)copies ot plane lor proposed work• Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Cer,terline ol street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> propose.f siructures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS I.INE <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 2A hrs. in advance•phone 259-88�b. � <br /> 2. All work shell be performed in accordance with Ihi�permit and current City of Everett Design and Conslruction <br /> Standards and Specifications. <br /> 3. Call Location Urti=rground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•$5$$. � <br /> � `v�UF � / O <br /> o�' �d•9�.f-iv y c��-9�. <br /> i�c�' PFo�s'r���JS TO P/�'r�^ � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owneUapplicanl herehy agrees to holtl and save harm- <br /> less the City of Everett from any and all claims for damages. cosis, <br /> enpenses, or causes ot action that may arise becausi� ol installation <br /> �����T � ��� and maintenance ot Ihe improvement or other right-ol-way use herelo <br /> applied for and lurther agrees to remove same upon notice trom the <br /> Appr�r Construction � ' Date City and to replace public property dama�ed ihereby. <br /> �—��1fr�_ i� ' � J <br /> � �v-/6 -/'� /' l <br /> FINAL INSPECTION Date �-^ �� 7��� <br /> Approved ae�Constructetl Signature M Applicant—� _ ' Oate <br /> everett PUBLIC WORKS f1EPARTMENT WORK AUTHOR�2ED BY THIS PERtdIT MUST B[ STARTED WITHIN <br /> � 3200 CedarStreet 180 DAYS OF OATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259-b815 CANCELLED BY ThE!'ITY UPON ANY STOPf'AGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />