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Date�7 Public WOrks Permit� �--- <br /> p�- JSf3 <br /> Application For Bldg.Dept.r J�l J7 �r/,(Z/ �3 <br /> PUBLIC WORKS PERMIT PUOToIeFooFee S <br /> Lass AOPL Pea Pa�tl $ <br /> � <br /> ea�aoce oun g_ o'ZO� <br /> Print or Type Only — <br /> � �� , R� a � s2�-�9� �a .r�- s� .�fc, �.�� p�o�z ��� —�i�s <br /> Owner Mailing Address City Zip Phone <br /> , o�,d ��� �-4—�„A;,6;�� � ci,.,i.,� ;..� ���3c _ <br /> Applicant Mailing Address� City Zip Phone <br /> PescriboProposedWork �v r�1„) C� �� ��/C'���L�QI`1{' <br /> W <br /> Pro�ect Address�if known) �� — E���mO �N � <br /> Attech four(4)copies of plans for proposed work- Draw to scale and note the following as applicab�e: � <br /> • Property Lines • Centerline ot street � <br /> � Outline and dimensions of ell existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Exlsting and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> i. All cails for inspection shall be rnade 24 hra in advance• phone 259•881 5. � <br /> 2. All work shall be performod in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specilications <br /> 3. Cell Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> � I.✓s:�j�c .l�.Piv.�«�qy Cu� Gor �f2 Crr,� �'F O <br /> F✓<-,�Err� S;��oA2.� � _3c�7 , <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe Ciry of Everett trom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> ���r_� �0 2 and maintenance ol the improvement or other righFof-way use hereto <br /> ����� applied for and lurther agroes to remove same upon notice irom the <br /> Approved for Constru n Date City and to replace public property damaged thereby. <br /> 7r�v ///' <br /> FINAL I SPECTI N Date �, � (/ ���«��� <br /> Approved as Constructetl Signature o A p icant � Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZ[D BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMlT i� ISSUED ANO THEREAFTER IS TO <br /> Everett,WA 96201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF\NORh ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />