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Date�o � Pub6:WorW Permu• <br /> ApplicationFor BItlO-Dept• �'7 ��� <br /> PUBLIC WORKS PERMIT P�bTOI�FeeF�� S <br /> Less Oppl Fee PaiE $ <br /> Baiance Oue S <br /> Print or Type Only <br /> lZuss .e o� �4�7 /1'�a ia�L0.._/���' !:�Prelf 334— �'.�Q3 <br /> Owner Mailing Address City 2ip Phone <br /> CreJ� Co„stCrre �#lnrr �Q,�t`�� � C.vhN����� 775-� �8' � � <br /> Applicant Mailing Ad ress Cd Zip Phone <br /> Describe Proposed Work Q�� ✓1 au� '�q(`/'!�A 1 b CP OY' ,�jS(i f(�j�a <br /> ` � W <br /> Project Address(if known) 7 M7 v � Ul �/ _ � <br /> Attach four(4) copies ol plans for proposed work- Draw to scale and note the fol�owing as applicable: � <br /> • Property Lines . • Centedine of street � <br /> • Outline and dimensions of all existing and A Indicate North <br /> proposeC structures on the lot • Show any proposed grading changes <br /> • Existing and proposed ulilities • Show measurements /M <br /> W <br /> DO NOT WRtTE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspection shall be made 24 hrs. in advance• phone 259•8815. � <br /> 2. All work shall be performed in accordance with Ibis permit and current City of Everett Design and Construction <br /> Slandards and Speci(ications. <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> ���Cl,oz��.�i»u-t�'�J�o-Y` �'art�e�� 'S'i�.s/97 O <br /> b �� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS I <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the Ciry of Everett from any and all claims lor damages, costs. <br /> expenses, or causes of action that may arise because of insta�lation <br /> and maintenance ol the improvement or other rigM�o6way use hereto <br /> — applied for and further agrees to remove same upon notice irom the <br /> Approved for Construction �a�e City and to replace public properry damaged thereby. <br /> FINAL INSPECTION Date -- <br /> Approved as Conslrucled Signature of Applicant Date <br /> evere�t PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Codar Sircet BE DILIGENTLY PURSUED TO COMPLETION. Th115 PERMIT MAY �G <br /> Everetl.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIF <br /> Phone: 253�8815 PROJECT OVER 90 DAYS DURATION. <br />