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- i <br /> Date��� PubLc Wo�hs Permit� <br /> ArollcationFor p1°a�DCp1�a �`� ��� <br /> PUBLIC WORKS PERMIT P°�°°W°��=F°° <br /> .o���Fao a <br /> Less nooi.Fee ve�e S <br /> ealonce Oue $ <br /> Print or Type Only <br /> Dr T�sl���. Slnnu� /OSD C�„�,� �� 1.. ✓ei�l� ��Lo3 zs2 -13�� <br /> Owner Mailing Address City Zip Phone <br /> 1�aVE. I��ts�n I(35�1 N� A�r�. A� �✓E�P7`f l�zo3 z59-2g5C� <br /> Applicant Mailing Atldress City Zip Phone <br /> Describe Proposed Work Q � � � ��v s/NCc(L, ��F���� �i rJ <br /> —�-e-�d.l�-_ �,� s ,� <br /> W <br /> Projecl Address(if known) � <br /> Attach four(4)copies of plans lor proposed work• Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline of sireet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utililies • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls far inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed i�accordance with this permit and current City of Everett Design and Construclion <br /> Standards and Specifications. <br /> 3.Call location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> �Uk3GiG C,�/p�'�+� /��,E'iniT it/OT �-�vi/'�� O <br /> �� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned o�vner/applicant hereby agrees to hold and save ha�m- <br /> less the City ol Everelt trom any and all claims lor damages. costs, <br /> expenses, or causes ot action that may arise because of installation <br /> and maintenance of the improvement or other right-o4way use hereto <br /> applied lor and further ac�rees to remove same upon notice Irom the <br /> Approved for Consiruction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE ;iTARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 32UOCedarStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MhY BE <br /> Everelt.WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />