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, <br /> �B�B� c� Puebcwo,�aPermit. � '� <br /> AppliCe�ion Fof P�nc Deo� � — — <br /> PUBLIC WORKS PERMIT PUM�cWorMsfee <br /> Ta�ei f�e S __ <br /> Le�s�D�l IeeP��� S <br /> Print or Type Only es�.���o�s f �� <br /> � � --�2n�t,n �y�q��� �� ��+�- �s �-R�19� <br /> Owner MaiMng Adtlress Gly Zip Phone <br /> : X-LiY i lL <br /> ApplicaM Mailing Address Cily Zip phone <br /> Denaibe Proposed Wmk __�� l <br /> Project Addresn(11 known) �� � _ � <br /> � <br /> Attech low(4)capies of plena lor proposed work• Orew to scele and note Ine lollowing as applir.a6le: � <br /> • P�operty Linen • Centerline o�streel � <br /> � Ou�line end dimennions ol ell exisung and • Indicale North <br /> proposed struc�ures on the lot • Show eny proposetl grading changes <br /> • Exlsting end propoaed utllities • Show measurements � <br /> '�n N07 WRITE BELOW THIS LINE <br /> PERMITCONDITIONS O <br /> t.All calls lor inspectlon shel!ba mede 24 hra.in advanca-phone 259•8810. � <br /> 2.All work ehell bn peAormed in aecordence wllh thls permit and current City of Everett Design end Conatrucllon <br /> Standerde end Speclllcetlone. <br /> 3.Call Lxetlon Undergiound Servlca 48 hra.belore you dlg.TOLL FREE NUMBER 1-800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The imdersigned owne�/eppllCanl hereby agrees�o hold and save herm� <br /> less ihe Cdy ol Everetl Irom eny and all cleims lor demegee, costs, <br /> O e�penses. or causes o� aclion fhat may erise because ol installetion <br /> 3 9B nnd maintennnce of Ihe improvemenl or o�her nghl-ol�wey use hereto <br /> epplied lor end lurther agrees lo remova seme upon notice irom the <br /> Approved lor isiru� ,� Da�e Cily and to replace public proper�y damaged thereby. <br /> � -��-�� B� <br /> FINAL INS ECTION Dele 2 <br /> Approved es Constructed alure of AppGcant � DaIE <br /> eveiett PUBLIC WORKSDEPARTMENT W K AUTHORIZED B TNIS PERMIT MUST OE STARTED WITHIN <br /> � 3200CetlerSlreal 180 DAVS OF DAT[ PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everell,WA 98201 BE DILIGENTLV PURSUED TO CGMPLETION. THIS PERMIT MAY BE <br /> Phone.259�BB10 GANCELLED BV THE CITY UPON ANV STOPPAGE OF 4VOPN ON THIS <br /> PPOJEGT 9VER 90 DAVS DIIRATION <br />