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� <br /> .d <br /> Date��b `� �4 �� Z <br /> Publit Warkn Permi�+ <br /> ApplicaliOn For Biap.Oevt.• 3 0 <br /> PUBLIC WORKS PERMIT P°°'�°W°"�F°° _ <br /> rma�Faa s a-o• v v <br /> Le¢a AppL Fee Paitl S <br /> Balence Due S d-�'�� <br /> Print or Type Only ���P <br /> L �C012�t' ��OM1H.� CQOOoZ � �h�H7l`c�CIR� L�f� ���� �`SJ-' �c/`3� <br /> Owner Mailinq Address City Zip Phone <br /> �h� � <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work i'�N�S�I ��24��—a�2 P �veiZ �`�¢2/��4 '�V / � JIN f � C� \ <br /> C-Gn���leJ�t CA�N �w eT ( )Areiw.ucc� �'P.-nJ`Ted. —�,rZ <br /> O' Sc <br /> W <br /> Project Address(il known) Q� C� ~ <br /> Attach lour(4)copies of plans for proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ol sireel � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed struclures on the lot • Show any proposed grading changes <br /> • Existing and proposed ulilities • Show measurements M <br /> W <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•881 5. � <br /> 2. Ail work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•80�1•424•5555. <br /> � <br /> j� Ead, bld� r..,KS} � cor�«����9 1,� q s �..,le s ,de sr,...� �i <br /> �-�o � w. ,.;. 'r�ne P o s .,5� �I a s l. ,,.. : -4L, c e,.., <br /> rw (Lr0. S{1[�r� f� [0.�.�f wt 1w XIS� N� � <br /> .1 � �T T <br /> w.�• s,�� e �. w�.� � �o� p� ,.. � � <br /> !'tw+�� ¢ u s s�.o .�. i�' v.�,�s� b< o.l {ers.� �v. � O <br /> -+wo s�er.J�< u�.,he��,or,l. a <br /> ACKNOWLECGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm- <br /> less the City ot Everett from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> � L/�LN—� y/O-�y and maintenance of ihe improvement or other righl-ol-waY use hereto <br /> applied or and furiher agrees lo remove same upon notice from the <br /> o f r � ction a�e City a d to eplace pi� lic prope damaged thereby. <br /> i <br /> ` � L � _ <br /> FINAL INSPECTIC. Dale �~ - � �� <br /> Approved as Constructed gna ure of Applicant Date <br /> � ORK AUTHORIZ`D BY THIS PERMIT MUST BE STARTED W�THIN <br /> everett PUBLIC WORKS DEPAR7MENT 180 DAYS OF Dl,TE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everelt,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 pROJECT OVER 90 DAYS DURATION. <br /> 1 <br />