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Date�a V Pu01rc WorkaPermit• <br /> ' J�, 7 �� <br /> Appliwtion For e�ea oev�.• <br /> PUBLIC WORKS PERMIT P°°"°W°��°��° <br /> iotal Foe s <br /> leif Appt Fee Pe�C S <br /> Pfifli Of TypB Ofily BelanceDue S <br /> �, rr4� Amer�can T,-�le 31G�` Cold.. /��e .Fvere!-f ass--yioy <br /> Owner Mailing Address City 2ip Phone <br /> �q ��� �,��,�I,� 39/a ,d.;�la, � 3���,�,:ti�,�, w,4 ��i- �s'�� <br /> Ap ant MailingAddress Ci� Zip Phone <br /> Describe Proposed Work re J�Dn� 1 mT)/o J�}M�n f' <br /> /� W <br /> Project Address(if knowo) � L�n � � <br /> Attach four(4)copies ol plans for proposed work• Draw to scale and note the loliowing as applicable: � <br /> • Property Lines • CeMerline ol stree� � <br /> • Outline and dimensions ol all existing and • Indica�e North <br /> proposed structures on the lot • Show any proposed grading chai�ges <br /> • Existing and proposed Wilities � Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 hrs. in advance•phone 2S9•8B1$. � <br /> 2. All work shall bo perlormed in acwrdence with this permil and current City ol Everel�Design and Construction <br /> Stantla�Cs and Specificalions. <br /> 3. Cail Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> NO ��Bc�a' l.�lo,2.Cs �`'E.�i�iT .PFQvi,�d /��86 O <br /> �� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm� <br /> less the City ol Everetl Irom any and all claim, for damages, costs, <br /> expenses, or causes ol action ihat may ariso because ol installatlon <br /> and maintenance ol �he improvement or other nghFol-way use hereto <br /> applied for and luriher agrees to remove same upon notice Irom Ihe <br /> .�pproved lor Construction Date City and to replace public property damaged thereby. <br /> FINAL WSPEC710N Date <br /> Approved as Constructed Signature ol Applicant Dale <br /> everett PUOLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreel 780 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BY TH[CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PpOJECT OVER 9U DAYS DURATION. <br />