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<br />� f Date.�_O.�. '�^�� ^B B Public Works Fermlt•
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<br /> Application For eiea-oeoi.+_T
<br /> PUBLIC WORKS PERMIT PubTolelFee�eB S '
<br /> Lnse Apol.Fee Pala S Q — �
<br /> Balance Oue S v�7 S/ .;(:�
<br /> Print or Type Only P¢{
<br /> � ►v�e�.�� ,�7 �D «ia c �o�/ a 5 9- 3i��
<br /> Owner Mailing Address Ci!y Zip Phone
<br /> ,?== YVI�'
<br /> I Applicant Mailing Address City Zip Phone
<br /> ,� . ' [.� �M� � ST�r ts a p c i�
<br /> Describe Proposed Work .�h D S� AP� � �
<br /> bu ;I r�; ✓�c� 'Fer�t �1 G rw� a�l�(�n���a� /d�i�-
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<br /> Proiect Address(if known) Z�-3� — a�OF�OGc1P� _ �
<br /> Attach four(4�copies of plans for proposed work• Draw to scaie and note the following as applicable�. �
<br /> - • Propeny Lines . • Cenlerline o1 slreet �
<br /> . • Outline end dimensions oi all existing and � Indicate Norih
<br /> proposed structures on the lot • Show any proposed grading changes
<br /> � • Existing and proposed utilities • ShoN�measurements /�
<br /> W
<br /> , DO NOT WRITE BELOW THIS LINE O
<br /> PERMIT CONDITIONS
<br /> 1. All calls for inspection shall be made 24 hrs. in advance• phone 259•881 5. �
<br /> 2. All work shall be performed in accordance with this permit and curtont City of Everetl Design and Construction
<br /> Standards and Specifications.
<br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424-5555. �
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<br /> /�C„� B9i i/ S�r £ O.0 �f/ M'.^..;.r',/.- Sr'!'C_FS N/�rP?[�:��,G.
<br /> � ��/ / � ��Hd� /n� ���KNOWLEDGEMENTOFCONDITIONS
<br /> �'/9 ��l�
<br /> ,�Jp�. � �- �� ���� d ,�ly�y �r1�do�+ner/apPlicant hereby agrees Ic hold and save harm-
<br /> / �Yes's Ihe City of Everett Irom any an� all claim� for damages, cosls,
<br /> �� ��`� expenses or causes ol aclion lhat may arise because ot installation
<br /> �/',� ,�p�sy ��"J�S -$7 and mainlenance of the improvement or other ri�ht-of�way use hereto
<br /> applied for and lurther agrees to remove same upon notice from the
<br /> Ap ved lor Constru i� Date City andllo replace public property damaged thereby.
<br /> 7
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<br /> � �/,`o�e � ��"�" ,��/,�/(�//�✓T�1� /l�'��� �
<br /> FINAL INSFECTION
<br /> , � gna ure of Applican� 'Date
<br /> PUBLIC WORKS DGPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN
<br /> everett 180 DAVS OF DATE PERMIT IS 13SUED AND THEREAFTER IS TO
<br /> � 3200 Cedar Sireet 8E DIIIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE
<br /> Everett.WA 98201 CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS
<br /> Phone: 259�8815 pROJ[CT OVER 90 DAYS �URATION.
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