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n �7<'�,� <br /> Date�:�u P�o��wo�ks P�,m,�c�. 1 <br /> Application For eioe o�P�.•� �1 - <br /> PUBLIC WORKS PERMIT PUOTo�FeeFee a <br /> �ese noo�Fee Pa�a S <br /> Bolanco Due S <br /> Print or Type Only <br /> Il7vini^� I � lil�{�I►1�v1d'I �:�'� rl l?'p�����x � u �'.tc.l 9�g 338�9�d <br /> Owner MailingAddress City Zip Phone <br /> ��"���� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work —�. �n 1 � � �U -- <br /> /� W <br /> ProlectAddress�itknown) c���� �� ! "/�, � <br /> Attach lour(4)copies oi plans fc•proposed work• Draw to scale and note the tollowing as applicable: � <br /> • Property Lines . • Centerline of street � <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 utilities � Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PEP.MIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259•881 5. � <br /> 2. All work shall be performed in accnrdance with this permit and current City oi Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � �/NJ � <br /> D�// � <br /> �//— <br /> 1� =,;-� ��� o <br /> � . <br /> � � a <br /> �o ��-� �,�a/ <br /> y I� <br /> / ��,�� i � ° ACKNOWLEDGEMENT OF CONDITIONS <br /> l.!Y�� ��� � aned owner/applicant hereby agrees to hold and save harm- <br /> � ' 97L`� 6 � y of Everett Irom any and all claims tor damages, costs, <br /> �" �� r causes ot aclion that may arise because of installation <br /> /� ance ol the improvement or other right-of•way use hereto <br /> Y i �� �nd furiher agrees lo remove same upon notice Irom ihe <br /> Approved for Conslruction T� � �place pubiic property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Cons!ructed Signature ol Applicant Date <br /> evere[t PUBI IC WORKS D'ePARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 18G DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />