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Dat�.���s • <br />ApplicaVion For <br />PUBLIC �91/ORKS RERMIT <br />Print or Type Only <br />• nuoi¢ WoiMs Perml a <br />s�.�e. oeot.,�i�S.� 6 %� <br />o��b6c Works Fac <br />Total Fee 5 <br />less Appl Fee Pai� S <br />E�alanceDoe �u <br />�i{VI9t`� 17�5�-'L-�C� �!¢ l��r G�,,;_r"r�iJ'fi 99�'`' '� I=�� <br />Owner MailingAddress Cily — Zip �Phone <br />Applican� <br />iling Address <br />City <br />Descri6e Proposed Work �t�t,c�l� ���� �yUb 7�� �'—a� ��l � i�'l� �� � <br />Projec� Address (if known� <br />Attach four (4) copies ol plans for proposed work - Draw to scale and note the followinq as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on Ihe lot <br />• Exis�ing and proposed ulilities <br />PERMIT CONDITIOI�'S <br />• Cen�edine of stree' <br />• Indicate Norih <br />• Show any propose�i grading changes <br />• Show measuremeNs <br />7. All catls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be perlormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-$00•424•5555. <br />l�//� �6G'�C� Gvb,eF�- �c����— �'Fqv.,ec�'v <br />��� /��2�r?'S <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� � he undersiqned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett Irom any and all claims for damages, rosts. <br />expenses, or causes ot action thal may arise because of inslallation <br />�' and maintenance ol lhe improvenenl or other right-of-way use her?to <br />-- applied for and furiher agrees to remove same upon notice Irom ihe <br />Approvzd for Construc�ion Date City and to replace public property damagetl Iherr,by. <br />FINAL INSPECTION <br />Approved as Consirucled <br />evcretl �'UBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everelt. WA 98201 <br />Phone: 259�BB15 <br />Date <br />Signafure ol ApplicaN Dale <br />WORK AUTHORI2ED BY THIS P[RMIT MUSI' BE SiARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />car�CELLED BY TH[ CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. - <br />