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Date__4'��(= / PUELCWork�PE�mii1 � <br /> i � <br /> Application For e�ec oeo�.•�7 <br /> PUBLIC WORKS PERMlT PuolmWorbPre <br /> Tolel Fee s <br /> les�AOP��Fee PUE f <br /> Belence Doe S <br /> Print or Type Only <br /> So�„ So�e�� � 0 a R�n�r�,y�. F_�u.o/� 9d' d59-oOd� <br /> Owner J Mai ing Address Cdy Zip Phone <br /> l�p�� �, e �o�v��-1 ._._ �Dl� dd7�< CJ'� /=�.w� 9�al�'S 33s/-7Us�� <br /> Applica t Mailing Address City Zip Phone <br /> Describe Proposed Work 7enr. !`�I�,�,.�(�ilsP� � <br /> — � <br /> Prolect Address(if known) � <br /> Attach lou�(a)copies ol plans for proposed work- Draw to scale and ote the following as applicable: � <br /> • Property Lines • Cenlerlinia of sireet � <br /> • Outline and dimensions ol all existing and • Indicate North <br /> p�oposed siructures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measwements � <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•881 5. � <br /> 2. All work shall be pedormed in accordance with this permit and cwrent City ol Everetl Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Serv�ce 48 hrs. belore you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> �v6'c�c c;c/o.r�',Fs f^'�%';�,i /�.�nr .�'E'�,'oi.��v <br /> ar/J�'�� � <br /> ��"_ � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> — les= the City ol Everett from any and all claims tor damac�es. costs, <br /> exp=.ne.es, or causes ol action Ihat may arise because ol installation <br /> and mainlenance of the improvement or other righbol-way use hereto <br /> Approved for Construclion Date applied Cor and furtherlagrees to remo��e same upon notice Irom the <br /> Ciry and to reolace pub ic property damaged thereby. <br /> FINAI INSPECTION Date <br /> Approved as Consiructed Signature of Applicanl Da1e <br /> evcrett PUBUC WORKS DEPARTMENT WOHK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WI7HW . <br /> � 32UOCedarStreet 780 DAYS OF UATE PERMIT IS ISSUED ANU THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. TI11S PERMIT MAY BE <br /> Phone: 259�8875 CANi.ELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> 1 <br />