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Date��7 ��„���,vn..,„�����. <br /> App�ira�ion FOt E��`� ��n� � ���'3�i-- <br /> PUBLIC WORKS �'ERMIT P°°;o„F«`°° : <br /> Less Aoo�.Fca Pnie S <br /> BaianceDue s <br /> Print or Type Only — <br /> JP( � Pr �✓>�r a�aa r���M �✓F/P1f' J��LO� o�S�—,3Q/� <br /> Owner Mailing Address C1ty Zip P`.,ne <br /> So w+t <br /> Applicanl Mailing AAdress City Zip Phone <br /> � 3rrJ n.,�.. o� <br /> DescribeP�oposedWork �na,y,�� iMa/Z`✓PN'10H ON � <br /> _ /I1Jl�iM �—�P 6�n/ � Uiti �I`1/w� <br /> W <br /> Project Address Gt known) � �d -� �� f � <br /> Attach four(4)copies ol plans lor proposed work- Draw to sczle antl note the lollowing as applicable: � <br /> • Propa�ry lines • Centedine ol street � <br /> • Outline and dimensions of all existing and • Indica�e North <br /> proposed structures on Ihe lot O Show any proposed grading channes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls lor Inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit and current City ol Everett Design and Construction <br /> StanAards and Specitications. <br /> 3.Call Lowtion Underground Servicr 48 hrs.be'ae you dig.TOLL FREE NUMBER 1-BOn•424•5555. � <br /> J� O <br /> /`!/BL/C G��U�S �•2r»iT�OT i('r�Ui,C�G� H <br /> /,�'/7-Ei'7 <br /> �-%�` tA <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF GONDITIONS <br /> The undersigned owner/appliwnt hereby agrees lo hold and save harm� <br /> less the City ot Everett Irom any and all claims for damages, ccsts. <br /> expenses, or causes of action ihat may arise becausc of mstallalion I <br /> and mainlenance oi the improvemen� or other nghPol-way use nerelo �� <br /> applieQ lor and Iwiher agrees to remove same upon nolice irom ihe I <br /> Approved for Conslruction Dale Cily and to replace public property damaged thereby. I <br /> FINAL INSPECTION pa�e II� <br /> Approved as Consiructed Signalute ol Applicant Date i <br /> rverett PUBLICWORKSDEPARTMENT WORK AUTHORIZ[D BY THIS PERMIT tdUST BE STARTED WITHIN I <br /> � iB0 DAYS OF DATE PERMIT IS ISSUED AND fHEREAFTER IS TO <br /> 3200CetlarStreet BE DILIGENTLY PUR5UED TO COMPLETICN. THIS PEPMIT IdAY BE i <br /> Everett WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF\NORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />