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Date 8 a 9 B� °��I¢Worhe Parm�t� � � � <br /> Application For eiap oso�.• <br /> PUBLIC WORKS PERMIT '°°;�„FeeFee s , 00 <br /> — <br /> Laes Rpp1.Fee Psitl 5 � - � <br /> Bale��ce Oue S �- �� <br /> Print or Type Only � ���� <br /> 1�P,u�D � Fi�Nr� � Ex�x 4<� rrluKi �.Tce l��a QR� 7.5 353- �, �7�1� <br /> Owner Mailing Address City Zip Phone <br /> � ^ , <br /> �u �n c. (�� �nIT7� t��x 456 I�ti�� � �.�i co ��� 98� �� �>53-G 74�s <br /> Applicant Mailing AAdress City 2ip Phono <br /> L.L. 7 r <br /> Describe Proposed Work � ' <br /> �.C`�_�I.IGTGLZl�n�15� ��C; yc/s c�� i I l ck I �uc•!� <br /> T�QIn C�`rlCff�lE',f C��'� <br /> - W <br /> Prolec�Address(il known) 3 t. v •G w — � <br /> Attach four(4)copies of plans tor proposed work� Dra �o scale and note Ihe�olluwing as applicable: � <br /> • Property Lines • Cen��rline of street � <br /> • Outline and dimensions of all exisling and • Indicate North <br /> p�oposad stiuctures on the lot • Show any proposed grading changes <br /> • Exis�ing and proposed utilities • Show measuremenls M <br /> W <br /> �s DO NOT WRITE BELOW THIS LINE <br /> PEFMIT CONDITIONS O <br /> 1. All calls for inspeclion shall be made 24 hrs. in advance- phone 259•88�5. � <br /> 2. All work shall be performed in accordance with this permit and current City ol Everett Design and Cunshuction <br /> Standa�ds and Specilice�ions. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> 7• �f�:..a`G. �w pf�Per-�-�eo �o t�e 3o�N or �Mes �— wta.J� <br /> ro �- be bl��-��. J"7�.�,.,43� ,. �. b� .,�.,,��.Q O <br /> Q�DN� �I I aF[1 � ` �CS N�flJ�• • � <br /> � <br /> O <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanf hereby agrees to hold and save herm- <br /> less Ihe City of Everett from any and all claims for damages, costs, <br /> �� expenses, or causes of action that may arise 6eceuse of ir�stallation <br /> p-3 v••�� and mantenance of ihe improvement or other right�ol•way use hereto <br /> � — applied lor and lurther agrees to remove same upon notice Irom Iha <br /> proved for struc � Oate City and lo replace public property damaged thereby. <br /> _� <br /> � �r'a1��f � <br /> ��� � ������ ��� <br /> INAL INSPECTION Date ' <br /> ApprovedasConsiructed Signat e�'b ppli nt Date <br /> WORK AUTHORI2ED BY TNIS PERMIl MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAVS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett.WA 90201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 PROJECT OVER 90 DAYS DURATION. <br />