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r <br />1 <br />Date1L� �g-611 <br />PUBLIC <br />Application For <br />WORKS <br />P <br />MIT <br />Print or Type Only <br />1 <br />q g <br />CS`pryrk�•1L errv-P¢ 13t3' <br />t"-o2 1 <br />iC I <br />Q <br />Tt� 1 <br />Owner <br />Mailing Address Y <br />Applicant <br />Describe Proposed Work <br />vuexc woa. ►wmn . ✓ <br />Bldg Deer <br />Public vi r z Fee s -- <br />TMeI Fes <br />L e.. &W Fee fh,d { �— <br />Bebnce Dna <br />A2NO a <br />WI <br />Project Address lif known) <br />Attach four (4) copies of plans for proposed work Draw to scale and notethe eoferline of streeing as it able: <br />• Property Lines • Indicate North <br />• Outline and dimensions of all existing and • Show any proposed grading changes <br />proposed structures on the lot • Show measurements <br />• Existing and proposed utilities <br />DO NOT WRITE BELOW THIS LINE O <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. In advance •phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 40 hrs. before you dig. TOLL FREE NUMBER 1 -800424555 <br />O <br />// <br />Date <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City o1 Everett from any and all claims lot damages. costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improveme-' or other right•of-waY use hereto <br />applied for and further agrees to n ..ove same upon notice from the <br />City and to replace public pro <br />ertY damaged thereby. ' <br />I F/3d/fS <br />Sig Lure of APPllcanr <br />WORK AUTHORIZED BY T PERMIT MUST BE STARTED WITHIN <br />tP0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE <br />CANCELLED <br />THE <br />DURATION. ANY STOPPAGE OF WORK ON THI>! <br />EOVER DAYS D1 <br />