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<br /> Date � , ��' ' �a Pu�bc Worka Perma� �, 1
<br /> � APPlica�ion For �• emo oeo� • �` ' I ��`� � �' �
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<br /> ! PUBLIC WORKS PERMIT P°°,e,aFeaFee s ;
<br /> . ;� Less AnPL Fee Pa�E s �� 'I
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<br /> � Owner Mailing Address) ' r �a �.� Cdy Lp Phone �
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<br /> Applicant Mailing Address City Zip Phone �I
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<br /> !, Describe ProPosed Work ��L������ C ���)1�� �l� �1i- i . i�. i f����� � ���� �J.-y1�• �
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<br /> � Project Address(if known) -��Z 7- bn��-.��c'n.•
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<br /> ; Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: � �
<br /> � • Property Lines • Centerline of street �
<br /> • • Outline and dimensions of all existing and • Indicate North
<br /> ' proposed structures on the lot • Show any proposed grading changes
<br /> � • Existing and proposed utilities • Show measuremems /�A �
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<br /> i . DO NOT WRITE BELOW THIS LINE O ,,
<br /> �� ' PERMITCONDITIONS
<br /> ' 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•861 O. � ,
<br /> � 2.All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction ,
<br /> � Standards and Specifications. ��
<br /> j 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1-800•424•5555. �
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<br /> �� Senc� � -�i �»� �
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<br /> � �.{ S I S� IT OF CONDITIONS '
<br /> ; � J (� reby agrees to hold and save harm- �
<br /> j �E �er 1�)r IG L�fLn� nd all claims for damages, costs, .
<br /> may arise because of inslallation
<br /> �, � a d or other righDohway use hereto .
<br /> ' �j� � f�jpp`��. �� ^'',�� � move same upon notice Irom the
<br /> ! Approved lor Construclion De�e C.., _..- ...•..r����v�����v�uverry aamaged thereby. ,
<br /> � FINAL INSPECTIOPI Date Date
<br /> � Approved as Corstructed Signature of Applicant
<br /> WOFK AUTHORIZED BY THIS PERMIT MUST BE START[D WITHIN
<br /> ' evemn PUBLICWORKSDEPARTMENT 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO i
<br /> , � 3200Cedar5lreel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE �
<br /> Everett,WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS �,
<br /> : Phone:259-8810 I PROJECT OVER 90 DAYS DURATION. '
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