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Date�� PUUIic Works Fermil• <br /> Applica�ion For Biap Deo��• <br /> PUBLIC WORKS PERMIT PueTol�ieeFee s <br /> Lees Aoo�.Fee Pai� S <br /> Belance0un .S <br /> Print or Type Only <br /> ��Yrrn� �Jn�+�I.�N I�� P�KE,rZ Av� �'�1�2�T1' �-?c�� <br /> O nor Mailing Address City Zip Phone <br /> (n�nr" l'��s-r r��� I(G�/-I�� d��{'�t ��rE��S q��258 �Ll'`l� <br /> Applicant Mailmg Address City 2ip Phonn <br /> Describe Proposed Work J1L.(,l.� ���C <br /> _ 1 / - W <br /> Project Address(if known� _�� �� p V� � <br /> Atlach lour(4) Copiea of Dlans lor proposed work-Draw to scalo and note the lollowing es applicable: � <br /> • Property Lines • Centerline ol stree� � <br /> • Outline and dimensions of all exisling and • Indicate North <br /> proposed slructures on tha lot • Show any proposeC p�ading chnnges <br /> • Exlating and proposed utilities • Show measuremenls � <br /> r�s <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspaction shell be made 24 hre. in ad��ance- phona 258-881 5. � <br /> 2. All work shell be pe�formed in acwrdance with Ihis permit end current City ol Everett Desiqo and Consiruclion <br /> Stenderds and Specificetiona <br /> 3. Cell Locntlon Underground Service 48 hrs. beloie you dig.TOLL FREE NUMBER Y•800•424-5555. � <br />' ��BL•iG Ld�'.•_,ts fE:e'i>vT �1�7'�f'EC�r/�,e-�� -S i9-°'� O <br />� �«,�� � <br />� <br /> V� <br /> O <br /> a. <br /> ACKNONILEOGEMENT OF CONDITIONS <br /> The undcisicned owner/applicant hereby agrees to hold and save harm- <br /> less the CitY ol Ever?tl irom any and all clalms ior damagea, cosls, <br /> expenses, or causee ol action that may arise because of installation <br /> anA maintenence of lhe improvemeN or o�her righbo4way use here�o <br /> aFPlied lo� and luriher agrees to remove seme u�on notice Irom ihe <br /> Approved lor ConsUuc�ion Dale City and to replacn public property damaged thereby. <br /> FINAL INF,PECTION Date — <br /> F pprovod as Constructed Siflnature uf Applicanl Da�e <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Sireet 1�0 DAVS OF DATE PERMiT IS ISSUED AND THEREAFTER IS TO <br /> Everett WA 38201 BE DILIGENTLY PURSIIED TO COMPLETION.THIS PERMIT MAY BE <br /> Phune: 259�8815 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS OJRATION. <br />