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�8t8��'C� �u�bcwor��Perm�1• ��I� <br /> BiCy Oev� � � ��� <br /> Applicalion For <br /> PUBLIC WORKS PEf�AAIT PueTol�Fee�ee � <br /> La���on��Fae PUC S n^DO <br /> B�I�nc�Um � o`�'� <br /> Piint or Type Only <br /> .� 1 � �r-l� ��1i�v�� 3.37-yA�t� <br /> O ne Malling Atldress Ci Zip Phone <br /> �`��� Mallmg Address City Lp Phone <br /> ppp�icant <br /> Deacribe Proposed W�nk �� �� <br /> W ' <br /> Pm�ea Addrens(11 known) <br /> Z - C �..�nn,E ' � <br /> Attech lour(4)copiea ol plans lor propoaed work- Draw to acE ie and nole the lollowing as epplicable: � <br /> • Property Linea • Centerline ol slreet � <br /> • Outline and dimenalona oi ell eziating end • Indicate No�th <br /> propoaed etructurea on Ihe lot � Show any propoSed grading chanpe; <br /> • Existlnp end propoaed i�tilitlee � Show measurements M <br /> W <br /> DO NOT WRITE BELOW TMIS LINE O <br /> PEPMIT CONDITIONS <br /> 1. All calls lor inapectlon ehell be mu�e 24 hrs. In edvence-phone 259•881 5. � <br /> 2. All work shell be perlormed In eccordance wilh ihls pa�mit end currenl City of Everett Design and Consiructlon <br /> Stenderde and Specilicellone. <br /> 3. Cell Locatlon Underground Service 48 h�s.before you dig.TOLL FREE NUMBER 7•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> o��p,(L The undersigned owner/epplicent hereby agrees to hold antl save herm� <br /> less Ihe Cily oi Everell Irom any and all clains lor demepes, costs, <br /> e�penses, or ceuses ol action that may ariae because ol �nstallation <br /> r—�/�� �� /_� _ p7 and maintenance of Ihe improvement or other righl•ol�wey use hereto <br /> %�( �� epphed lar end lurther egrees to remtve s m upon nolice Irom Ihe <br /> Appioved for Construction /i<� Dale City and to re ece Puhlic ertY dama e Ihare6y. <br /> / <br /> �-'�l� ��' C ! 7 <br /> FI 11 SPECTION Dato � � '�� <br /> Approved as Constructed SigneWre ol Applicent Dete , <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBL�C WORKS DEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO � <br /> � 3200 Cedar Streel BE DILIGENTLV PURSUED TO COMPLETION. THIS PERM�T MAV BE <br /> Eve�ett,WA 98201 CANCELLED BV 7HE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phore'259�BB15 PROJECT OVER 90 DAYS DUF7A710N. <br />