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�� ^\ I Publ¢\Vorks Pormil s <br /> Date qp/���7 <br /> • Bltlq.Depl.r <br /> Application For <br /> PUBLIC WORKS PERMIT PueTotlFcoFee $ <br /> Less FoOL Fee Paia $ <br /> � E3alanceDuc � <br /> Print or Type Only <br /> �-IYvn�� S�ING LcE �td3 1 1JE 125Tt+ ST SEFl`rl'l�E Wbl, 3(oL�40Q <br /> D�p �Yi��V���'�+Q��jlailingAddress CitY Zip Phone <br /> ��R, Iz,a W .Dr}TotJ c�' `� E.DMDNAS 7�'�-'7'77�3 <br /> Applicant Mailing Address City Zip Phone <br /> DeScribe Proposed Work 1 � � �V ��-� � E���R� <br /> W <br /> Proiect Address�it known) � �� �G E v�2ETT t'�Ifl�-L W AY `�� — � <br /> � <br /> Attach lour(4)copies of plans for proposed work- Draw to scale and note the lollowing as applicable: � <br /> � Property Lines • Centerline of street <br /> • Outline and dimensions ot all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenls M <br /> W <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 oedormed in acwrdance with Ihis permit and current Ciry of Everett Design and Construction <br /> Stendards and Specifications. � <br /> 3.Call Location Underground Service 4B hrs.before you dig.70LL FREE NUMBER 1•800-424•5555. <br /> �i�t CJe� ���ru.� /G� �e�r>v�z.-� . O <br /> ���'' �" <br /> � <br /> � <br /> CL <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereoy.�grees lo hold and save harm• <br /> less the City of Everett irom any and all claims tor damages, costs, <br /> ezpenses. or causes of aclion thal ma)� arise beCause of insta�lation <br /> and mainlenance ol ihe improvement cr other ri9ht-of-way use herelo <br /> applied for and lurther ac�rees to rem�ve same upon notice Irom Ihe <br /> Approved lor Construction Date Cily and to replace public property damaged lhereby. <br /> f"INAL INSPECTION Dale Date <br /> Approved as Consiructed Signature of Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHID! <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEfiEAFTER IS TO <br /> � 3200 Cedar Street BE DILIGE�ITLY PUflSUED TO COMPLETION. THIS PERMIT "AAY BE <br /> Everolt,WA 98207 CANCELLEJ BY THE CITY UPON ANY STOPPAGF OF WOp'� Glr iHIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />