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Date��� ��,.���„ w�.�.��,.,�� 7�7�� <br /> APu�icnlion For Inn� ro�ni . ___��.�J.lGLJ�._ <br /> PUBLIC WORKS PERMIT ^°,r�������° :_- - <br /> lru�nt�� fee Pua S— <br /> �a�anrn Dur S <br /> Print or Type Only <br /> CA�t�E <br /> �_� � i�Iq � l�� �a�r� _ �� � -g3�n <br /> wner � �eil�ng Addres Cny Zip Phone <br /> � �� — <br /> Applicenl Maihng Address City Zip Phone <br /> Describe Pruposed Work �� l�J`'+r=_�!U C ___ ____ <br /> �} �' !�i - W <br /> P�oiect Adtlress li�known) I � � —1 �/ �_ � <br /> A�tech lour(4)copies ol plens lor p�oposed work � Draw�o scale ontl note the lollowing as apphwhle � <br /> • Properry Lines • Centerline of slre�t � <br /> • Outline end dimensions ol all e�is�ing nnA • InAicnte North <br /> p�oposed structures on the lot • Show any proposeA yreAmq chanycs <br /> • Exisling end proposed uti6ties • Show measuremenls � <br /> DO NOT WfiITE �ELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for Inspecllon ahell be mede 24 hrs.in edvance-phone 259•8810. � <br /> 2.All work ehall be pedormetl in accordance with Ihis permi��nd current Ciry of Everett Design nnd Gonstruction <br /> StanderAs end Specifications. <br /> 3.Cell locelion Underground 3ervice 4d hrs. belore you diq.TOLL FREE NUFABEN 1•800-424-5555. � <br /> /�T l'�✓ O <br /> z ��� �- <br /> � �� � <br /> 0 <br /> a <br /> �CNNOWLEDGfM11ENT Of CO�DITIONS <br /> Thr imdnrsigned owneriapphcan�he�eby agrees to hold Tnd save harm� <br /> I��ss ihr Gty o� Everett Irom any anA all claims lor tlamoges. mst5 <br /> expenses, or causes ol aclion Ihat may anse because ol installahon <br /> antl maintennnce ol Ihe improvement or olher nGhl-ol�way �ise herelo <br /> . npplieA lor and lurlher agrees lo remove same upon not�re Irom Ihe <br /> Approved lor Construclion Date Clty and to�eplace pubhc pronerly damaged there6y <br /> FINAL INSPECTION Dato — — <br /> App�ovod es ConsVucted Signature ol Apphcant ����' <br /> evrrrll PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PEF?MIT MUST BE STARiED WITHIN <br /> 0 3200CetlarSlreel IBO DAVS OF �ATF PEFMIT IS ISSUED AND iHEREAFTER IS TO <br /> Everell.WA98201 BE DILIGENTL� PURSUffI TO COMPLETION THIS PEf7A11T MAV BE <br /> Phono.259�8810 CANCELL[D BV ll�C CIiV Uf'ON FlNY STOPPAGE OF VJORH ON THIS <br /> PROJFCT OvfH��O I�AVS DUHATION <br />