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Date��'7 <br /> Pu06c l4orks Permit+ —7— <br /> App�icationFor eioo.oeo�.s�7�� // ��_� <br /> PUBLiC WORKS PERMIT PubTotelFeaFee $ <br /> Less eppl Feo PaiE � <br /> Print or Type Only e,m��ao�� s <br /> —�_k F��.11;n�v� � i I - a�S�-�, .J'f �F � /�� _PL//J'�l�4 qdoza <br /> Owner Mai6ng Atldress Ci�y iZ p hon� <br /> ,�Q u� O <br /> Ar.ulicant MailingAddress Cit <br /> Y ZiP Phone <br /> DescnbeProposedWork �P�uI[t�.Q be� �n�a�l' � <br /> Project Addreas(if known) �,(��j�Ql���V j � <br /> Attach four(4)copies ol plans for proposed work• Draw to scale and note the following as applicable: � <br /> � Property Lines • Centedine ol street � <br /> • Outline vnd dimensions ol all existing and • Indicate Norlh <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WpITE BELOW THIS LINE � <br /> PERMIT CONDITI6NS O <br /> i. All calis lor inspection shall be made 24 hrs. in advance•phone 258-881 5. <br /> 2. All work shall be perlormed in accordance with lhis permit and current City ol Everett Design and Conslruction ' <br /> Standards and Speciticationa <br /> 3. Call Localion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 7•800•424•5555. <br /> �/J3�' � <br /> PUBG/G Cdo.ef5 iPE".n_riii�t.bT I'F�Ia.,eEO / O <br /> ��� <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMEN7 OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe City of Everett irom any and all claims for damages, costs, <br /> �xpenses, or causes ol adion Ihat may arise because of installation <br /> and mainlenance ol Ihe improvemeM or olhei right-ot-way use hereto <br /> Approved for Construction Date aP d further es to remove same upon notice Irom the <br /> ity and to re ace p lic pr perty damaged Ihereby. <br /> FINAL INSPECTION Date � �—Z�"'g � <br /> Approved as Conslructed Signature ol Applicant Date <br /> everet� PUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST 8E STARTED 1YITHIN <br /> � 3200CedarStreet 780 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,Wq gg2p7 BE DILIGENTLY PURSUED TO GOMPLETION. THIS PERM�T MAY 8E <br /> Phone:259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE Of WnFK ON THIS <br /> PROJtCT OVER 90 DAYS DURATION. <br />