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Date/�f� Pub6�WOA�Permlt� �� — <br /> B�a9�DeW.e ���� <br /> Application For <br /> PUBLIC WORKS PERMIT °°°,oWF'�°°° s <br /> Lsna AOCt ree Pa�a s <br /> BelenteDue s �O <br /> Print or Type Only �3833 <br /> ' �,. � ���- � ��a <br /> Ow er Mailing Address City Zlp Phone <br /> i� <br /> SGiYY�C <br /> Applicant Mailing Atldress Cily Zip Phone <br /> Describe Proposed Work � ,v -� <br /> � � - a RS �t ('lAi r Sa�cn <br /> W <br /> Project Address(if knewn) � ' — � .OLdA � <br /> Attach four(4)copies o(plans for proposed work- Draw to scale and note the lollowing as applicable: � I <br /> � Property Lines • Centerline of street � i <br /> • Outline and dimensions of all ezisling and • indicate North � <br /> proposed structures on the lot • Show any proposed grading changes <br /> . • Existing and proposed utilities • Show measuremen�s M � <br /> W j <br /> DO IJOT WRITE BELOW THIS LINE O I <br /> 1 <br /> PERMIT CONDITIONS <br /> S. All calls for inspection shall be made 24 hrs.in advance-phone 259•681 5. � <br /> 2. All work shall be peAormed in accord.�nce with this permit and current City ol Everett Design and Construction <br /> Standards and Specifications. � <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•BOO•424•5555. � � <br /> 7 %O dE CONS%�r/CTEO f��' $�i� PLFIti� O . <br /> /�,aD!-'UG'�O /-� — S'G . <br /> � , <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONfi!TIONS <br /> The undersigned owner/applicant hereby agrees to hoW and save harm- <br /> less the Ci•y of Everetl irom any and all claims lor damages, coats, <br /> expenses, o: causes ot action that may arise because ot installation <br /> /^ � � /`— / � �6 and maintenance of the improvemeN or o�her ri hl'ol-way use hereto <br /> ��>� applied for and further agrees lo remove sam upon nolice Irom the <br /> Approved lor Cons ction ate City and lo r ace public property damaged t ereby. <br /> ���i��� 7 zY-K /J�� <br /> �INAt INSPECTION Date -�"i " <br /> Approved as Consiructed / ' Si ature ol `pPli n� Date <br /> everr.tt PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE S7ARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER 13 TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br /> Everett.WA 98207 CANCGLLED BY TH[CITY UPON ANY STOPF'AGE OF WORK ON THIS <br /> Phone: 259�8315 PROJECT OVER 90 DAYS DURATION. <br />