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s � <br /> App�icauon For Date <br /> � PUBLIC WORKS PERMIT public Works Permit N <br /> PUBLIC WORKS DEPARTMENT <br /> 3200 Cedar Street <br /> Everen,WA 98201 (425)257-8810 BuiIC' ;Pertnit 8 <br /> 00 <br /> TYPE OR PRINT ONLY Public Works Fee$ �S D`��.e�.a/ <br /> � 36G'-3sr - 0� � 3 <br /> �/ws.� •J T �5+c �3� a c �,— {/ 't�f ft'3-4 - I 7�(e 3 <br /> Owner Mailinp Address Ciry Zip Phone <br /> —��`� — y s� � 90 r ��,�.� se�l,�e w os i/� � _ <br /> Applicant Mailing Adtlress Cib Z�P �0�0 <br /> Describe Proposed Work � '� ~ � " � <br /> �! � � � O � <br /> � <br /> PROJECT ADDF+:SS (ii known) �-�1 �� �'� "- r� � <br /> O <br /> Anach lour(4)copies plans lor proposed work•Draw to scaie and note the following i(applicable: � <br /> •Property Lines •Outline antl dimensions of all existing and proposed structures on the lot •Existing and proposed utilities <br /> •Centedine ol sVeet •Indiwte North •Show any proposed grading changes •Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: O <br /> 1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br /> 2. All work shall be pertormed in accordance with this permit and curcent City oi Everett Design and � <br /> Construction Standards and Specitications. _ <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800-124-5555. /A <br /> \// <br /> � Lf/U�'� S/ia CL .Be dor�e �D¢r• Prav�o�P�o� O <br /> d-��✓ S- z¢-s9 ��Py k��Qd� 0. <br /> ACKNOWLEDGEMF.NT OF CONDITIONS <br /> � I L r c The undersignad ownedapplicant hereby agrees to hold and save harmless <br /> ����` ,y a��l 9 Me City o1 Everetl irom any and all claims for damages,costs,expenses,or <br /> pr e ons r ion a e causes of action that may arise because ol installatlon and malntenance of Me <br /> improvement or other right�of-way use her o applied tor and further agrees to <br /> t - remove same u otice from the City � to replace public p dam• <br /> l�� _ � —2 i -J f aged thereby. <br /> fINAL INSPECTION Dale �y <br /> Approved as Conslructed <br /> igna ure o p i a e <br /> WORKAUT}iOFIZLD BY THIS PC-RMfT MUST OE STAHTED WI7NIN 1B0 DAYS OF DATL-PE Il'IS ISSUEDPND hIERFJ�FTER IS TC�O[GIUGEMI.V PURSUE�TD <br /> COMPIl1TION.THIS P�RM(T MAY BE CANC�.LED BY THE CfTY UPON ANY STOPPAGE WOFiK ON TH�3 PRQE�TOVER 90 DAYS WfiA710N. <br />