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� Applkalion For Dat9 5— 3� 1,� <br /> � PUBLIC WORK,S PERMIT r-l'R �pc�. <br /> PUBLIC WORKS DEPAPTMENT Public Works Permit N <br /> 3200 Cedar Streal <br /> Everett, WA 98201 (425) 257-8810 8uilding Pertnit 8 <br /> TYPE OR PRINT ONLY Public works Fee$ ZS��' <br /> •i <br /> F <br /> _M/�J!fl �►9A b !�Al � � 373 i� S�/� 7�✓ S� 6vE�T'� v✓/-�- <br /> Owner ��Mailing Address Ciry Z'p Phone <br /> � �yZs� �3� 3��s� <br /> Applicant Mailing Address City Zi � Phone <br /> Describe Proposed Work �f/,���� W <br /> � <br /> � <br /> PROJECT ADDRESS (if known) � d� �� � <br /> Attach lour(4)copfes plans tor proposed work•Draw to scaie and note Ihe following if applicable: O <br /> •Property Unes •Outline antl dimensions ol all existing and proposed structures on the lol •ExisNng and proposed utilities � <br /> •Centerline of street •Indicate North •Show any proposed greding changes •Show measuroments <br /> DO NOT WRITE BELOW THIS LINE Z <br /> PERMIT CONDITIONS: O <br /> 1. All calls for inspection shail be made 24 hours in advance - phone (425) 257-8810 <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and � <br /> Construction Standards and Specitications., <br /> 3. Call Lxation Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800-424-5555. ♦A <br /> \O <br /> �. {(�,P �i�/ 5�e�5 c�le�n �t �, �I tiwtes . <br /> �J , InS��I �il'4570�1 COn+rol i�IGIcX�in � hot �iwt�� � �' <br /> �� It fU�1G�hg � a�� S� �205 ��+ hydro sE.�d'�n <br /> �the drs-�r5�d �,rc�s v✓� Cle�r�ng ;s comple�t . ►nst�u�� <br /> (?�1��{ G�5 i on co�-�o� as d i rL�kC� � (,i.�b �i� WrtrkS �h S�c��''� <br /> (i, �4�� �uMt �v Px�sk,�hq �ur.y 9v��,' ¢3 ����.-�l k shu�/ /�c <br /> �� �. y�G�i/�o� r�r(�ccd ? s d;rt��ec� by Pv5lrcworKs itis�-�✓, <br /> t�U �' lAnn,lt oK b SK� •��,� /� <br /> ACKNOWLEDOEMENT OF CONDITIONS h l�I/ �r <br /> � � � The undersigned ownerlapplicant hereby egrees to twM end save hertnless <br /> the Ciry ol Everetl from any end all claims tor demages,costs,ezpenses,or <br /> p ove or ruc io a e causes of action that may arise because ol instellatlon and meintenence oi Me <br /> improvement or other right�of-w use herero applied lor antl fuMer agrees M <br /> remove same u nodce f the City and ro replace public properry dam- <br /> c- � � ' - �G aged Mereby. <br /> FINAL INSPECTION Date � <br /> Approved as Constructed <br /> gna ro i n � a e <br /> WORKAUT}pR�D8Y7HISPERMRMUSTBESTARTEDWfTHIN1BODAYSOFDATE RISISSUEDMlD7FERF1IFIERI5i08EDl1GEMLYPUR�lEDiO <br /> CDMPLETION.iHIS PERA9T MAY BE CANCEIlFD BY THE CfTY UPON ANY STUPPACaE OF VVOFiK IXJ iHS PRQECTOVER 90 DAYS DURAiION. <br />