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Date�Q G ' � Pu�l¢Wods Parm�t• �`2� 7 <br /> Application For eiae oeai.a� __ <br /> P�IBLIC WORKS PERMIT P°°;oWF„a°Oe : _ <br /> Les�,Aonl Fna raiJ S�� <br /> DalencaDue � L�� <br /> Print or Type Only <br /> �iVMe� ;�p �"ya� 1�,►���xv� r��,�.,.� �s, .�i�c <br /> Owner Mailing Address City 2ip Phor.e <br /> .D G ���Cr�,o s,�o�-���ti � s� 9��9�5��a <br /> Applicant ailing Address City Zip Phone <br /> / <br /> Describe Proposed WorA — — <br /> /J / <br /> ---A+-f�' <br /> Project Address�if known) _�-���— GfE.r/Lclv��� ��E. _ �` <br /> f <br /> Attach four(4)copies of Clans lor proposed work• L raw to scale and note the following as applicable: � <br /> • Property Unas • Centedine of street � <br /> � Outline and dimensions of ail existing and • Indicate North <br /> proposed structures on the lot O Show any proposed grading changet <br /> • Existing and proposed utilities • Show mea�urements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. A11 calls lor inspection shall be made 24 hrs. in advance-phone 259•881 5. � <br /> 2. Ali work shall be performed in accordance with thi5 permit antl curreM Ciry ol Everetl Design ai d Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig TOLL FREE NUMDER 1•800•424-5555. � <br /> O <br /> � �. ��-� �' 7��lr•t",�o.� � <br /> � G.� .S doy loC�✓T�n';� V <br /> ' �� a <br /> .�� ACKNOWI.EDGBfdEIdT Or CONDITIONS <br /> � The undersigned owncr/applicant hereby agrees to hold and save harm- <br /> less the City ot Everett from anq and all claims for damag�s, costs, <br /> / expenses, or causes ol aclion tha: may a�ise because ol installation <br /> �(!=�l� . �� �/ �/�` and maintenance ot the improverrenl or other right-obway use hereto <br /> //ti �I7oa�s— T applied for anC lurther agrees tu remove same upon notice irom the <br /> Approven lor Cons ruction ' Date City and to replace public pro ry amaged thereby. <br /> ��7.�� � � �� g . <br /> FINAL INSP JN Dalc � <br /> Approved as Constructed gnat re o. ppli�anl Date <br /> everett PUBLIC WORKS DEPARTMENT ORK AUTHORIZED BY TIIIS PERI�IIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 18 VS OF DATE PERMIT IS ISSUED AND THF,�EAFTER IS TO <br /> Everett.WA 98207 BE D LIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8875 CANCELLED BY THE CITY UPON ANV STOPP%GE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />