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Date�AO Pu�l¢WO�Fs Po�mll a <br /> ' ' sa r s�Z <br /> Appliwtiaa For e�a9 oeo�.• <br /> Pl16LIC WORKS ►"'ERMIT PUeTotnPeeFee S -- <br /> Ll55�pP��F¢C PeIG $ <br /> Print or Type Only oa���«o�e s <br /> r1R �,�1 v11,,�1a,� aid� Colu,�b,a /��e -F-✓e��t�` 9�za3 3�7-3i5/ <br /> � Owner Mailing Address City 2ip Phone <br /> � JR Nt e <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work I'1 GFG1 � R a7n c� $� <br /> ' C IA W <br /> IProlect Address jit known) ���Z V�R HC1 /'! l/Q- � <br /> Attach lour(4)copies of plans lor proposed work- Draw to scale and note Ihe following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • OuUine and dimensions ot all existing and • Indicate North <br /> proposed structures on the lol • Show any proposed grading changes <br /> • Existing and propo5ed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for Inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be peAormed in accordance with this permit and curreN City of Everett Design and Consiruction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424-555F. � <br /> O <br /> �l/�GIG G�J���..�-�s �2n�ii �OT ,��QUi,e�2� �, <br /> `��� Z � 88 N <br /> �� O <br /> a <br /> 1 ACKNOWLEDGEMENT OF GONDITIONS <br /> � The undersigned owner/applicanl hereby agrees to hold and save harm- <br /> f less Ihe City ot Everelt from any and all claims for damages, costs, <br /> < expenses, or causes ol action that may arise because of installalion <br /> and mainlenance oi the improvement or olher right-obway use hereto <br /> applied for and further agrees to remove same upon notice Irom lhe <br /> Approved lor Conslruction Date City and to replace public property damaged thereby. <br /> t <br /> .i <br /> FINAL INSPECTION Date <br /> Approved as Conslructed Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY 7H15 PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF OATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarSireet BE DILIGENTLY PURSUEU TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PROJECT OVER 90 DAYS DURATION. <br />