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Date_L�7�1l.0 D� � �����_r:<�.�,�-�.,m,i� � <br /> ApP��Cafion For 6�eo oon��•� <br /> PUBLIC WORKS PERMIT P�bT01i1Fr�fae s <br /> LeMApo�FeePeW s <br /> Print o� Type Only Bel�nce0ue S __ <br /> l����'l'� `l�l �1 • �tn , �.�.� ����� ���r;�� � �l� ��l ' � ���'�`� ^i�J`-I � I —.. <br /> Owner ldaihng Addre�s' G�q� Zin Phonr <br /> ��127 — — — <br /> Applieanl Ida�iirq A�ltlresa Cdy� Z�p PhonC <br /> Describe Proposed Work /1�� <br /> Project Address lil known) �� � �� 2 � <br /> � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and nofe Ihe(ollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Oulline and dimensions ol all existing and • Indicate Nor!h <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and pwposed utilities • Show measuremente � <br /> � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspection shall 6e �ade 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be perlormed in accordance wi�h Ihis p=rmi�and currert Ci�y ol Eveietl Uesign and Conslroction <br /> Standards and Specilicalion;. <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �?G-4- ��c-�.�►�D O <br /> �� /O U��87 � <br /> � <br /> � <br /> a <br /> ACKNOWLf_DGF!.1[NT OF COIvDITIOIJS <br /> The undersigned ownei/apphcant hereby agrees to hold and save ha�m� <br /> less the City of Everelt lrom any and all daims lor damzges, costs, <br /> ezpenses, or causes of acDon thal may arise because of instatlation <br /> and maiMenance oi the improvement or other righl-ol-way use nereto <br /> applied lor and lurther ��.grees to remove same uno�� nni�rc Irom ihe <br />', Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Conslrucled Signature of Applicant Dati <br /> everelt PUBLIC WORKS DEPARTMENT WORK AUTNORIZED BY THIS PERMIT MUST dE STAR7ED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED PtaD TH@REAFTER IS T"O <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPL[T'JN. THIS PCF��.41T I✓�AV B[ <br /> Phone: 259-H815 CANCELLED BY THE GTY UPON ANY S70PPl.Ge OF VdORK oN iHiS <br /> PROJ[CT OVER 90 DAYS DURATION. <br />