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Date l0(.1/-�� Pu�b<WarXePermit• --�---- <br /> e�ea oeo� • � �--�U 7� � <br /> Appllcation For <br /> PUBLIC WORKS PcRMIT PueTotoFeeFee � _ <br /> Leff�pP� �ee Ps�E S <br /> Bei��ce Oue S <br /> Print or Type Only <br /> � � d ����� �v�v c�d� �d. E ,.�s.� - ���y <br /> � �IC 2 Pnone <br /> Owne� Maillnp Address City Zip <br /> v �� �'' — — Zip Phone <br /> Applicanl Malling Address City <br /> Dascrlbe ProPosad Work _5�,.. �L � 'Q ��" " ��� �p� <br /> W <br /> - �yro �.� n�i R.O � <br /> Prolect Address(1'known) <br /> w <br /> Attach tour(4)coples of plens lor proposed work- Orew to scale nnd note the lollowing es epF �able: � <br /> • Prnperty Unas • Centerline of stre�et <br /> • Outline end dimensions ol ell exisling end • Indicate North <br /> proposed structures on ihe lot • Show any Droposad grading chenpes <br /> • Ezisting and proposad u��litles • Shaw meesureme�its M <br /> W <br /> DO NOT WRITE BELOW THIS LINE � <br /> � PERMIT CONDITIONS � <br /> 1. All cells lor Inspection shell be made 24 hrs In ndvence� phonx 259•88�5. <br /> 2. All work shell be parformed in eccordance with ihls permlt end current City ol Everelt Design end Conatructlon <br /> Stenderda end Specllicetlons. � <br /> 3. Cnll Location Underground Service 4B hrs.before you Aig.TOLL FREE NUMBER 1•800•424•5555. <br /> ,� v�'°'�`' � .�' � <br /> �b �"bl` �`f y`� ���✓`�o�e �' � <br /> P�'��� 2�.�"'���,� � l��'��� O <br /> s��� b ��� �°�� a <br /> � � ,�/ <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The unde�signed ownedappticent hereby egiaes to hold end aeve herm� <br /> less the Gty ol Everelt from any end all cleims lor dameges, costs. <br /> expensas, or ceuaes of ection that may arise baceuse of Inatellalion <br /> ❑nd maintenence ol the impravement or other righf�of�wey use hereto <br /> applied for end furiher egrees lo remove seme �pon notice Ir�m the <br /> Approved lor r,onstructlon �e�P City and to replace public property demeBed ihereby. <br /> FINAL INSPECTION �e�e Oate <br /> Approved es Canstructed Signatwe nf Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everrlt PUBLiC WORKS DEPARTMENT 180 DAYS OF DATE PE�A�IT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cednr Slreet BE DILIGENTLY PURSUEfI TO COAIFLETION. THIS PERMIT MAV B[ <br /> Everett,WA 98201 CANCELLED BV THE CITV UPON ANY STOPPAGE OF WOFK ON TNIS <br /> Phone: 259-tiBt 5 pROJEG7 OVER 90 DAYS DURATION. <br /> � <br /> I � <br /> I <br /> � <br /> . � <br />