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DBte��f n�.dic Workf Permll s �+ �_/O _ <br /> Applicalion For Bltlp.Dep�.�_ <br /> � �T <br /> PUBLIC WORl�S PERMIT PU�TotelFeeFee s <br /> Lnse AOJ�Fau Paid .S—n <br /> BalanreDua S `�� <br /> Print or Type Only �3/� <br /> /Om hYA /T�h- <br /> Owner Mai4ing Address Ci;y Zip Phone <br /> �s��.r�� d-�Pe/� ll�/o/ O�, �^�Sa¢Iw�2v�� Q�y� SL� �a�- <br /> AppNcent Mailing Address City Zip Phone <br /> r <br /> � � <br /> Descrlbe Proposed Work `r��N �Pf�C�— <br /> `.a� `� C.�AP7�c�JdoO� — — <br /> W <br /> Pro�ect Addross(it known) ���5 — ���''��OO.t-' G:Qit/G__ � <br /> Attech four(4)copies ot plans for proposed work• Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensio�s of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed greding chanpes <br /> • Existing and proposed utilities • ShoN 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. All work shell be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards end Specifi:ntions <br /> 3. Call Location Underground Service 48 hrs. be�ore you dig.TO�L FREE NUMBER 1•800•424•5555. �* <br /> �� <br /> O <br /> � <br /> � <br /> O <br /> a <br /> / ACKNOWLEDGEMEN7 OF CONDITIONS <br /> ��1,K�6 _ The undersigned ownedapplicant hereby agrees ro holA and save harm- <br /> less the City of Everetl from a�y and all claims tor dama9es, costs, <br /> . expenses, or causes ol action that may arise because of installation <br /> � /�� � /O—B6 and maintenance of the improvement or other right-ol-way use hereto <br /> �l applied lor and further 2grees to remove s..��e upon nolice from the <br /> Approved for nstruction �a�e City and to replace public property damaged thereby. <br /> �����6��— ���.� . � �--1�-�-���T <br /> � � . <br /> �FINALINSPECTION Date . �- � <br /> Approved as Constructed Signature ol p cant Date <br /> WURK AUTHORIZED BY THIS PFRMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 7g0 D�YS OF DATE PERMIT IS ISSUED AND THEREAFTER I5 TO <br /> � 3200 Cedar Streel BE DILIGENTLY PURSUED TO COMPLETION.TFIIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STO�PAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />