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Date '-' <br /> . FUEIic Workt Psrmll• <br /> Appllcatlon For eiop.o.n�.• <br /> PUBLIC WORK� PERMIT °°°;o„FeeF�• : <br /> Lsu AppL Fee P�10 S <br /> Print or Type Only Bal�nce Due s <br /> Plpan Check No: g <br /> Owner APJob�at.Date; pg428%93 SEPA <br /> Ad�ner: 22b2 $L CAPI2A[1 Phone <br /> Tenant; EASTMOMT AUTO � � <br /> Propoaed Uee; R�ppIR <br /> Applicant �CONSTRUCTork; AUTo <br /> NEW �TpL �LRD Phone <br /> POLE BLDc; <br /> Describe Proposed Work _ OFFICE SET <br /> APPRO ��—JOB SET — <br /> — t7F.0 FOR PERMTT: Di,TE��—�-- <br /> ��� BY <br /> Project Address(if k�ownj � <br /> AttaCh four(4)copies of pians for proposed work• Draw to scale and note the follawing as applicable: � <br /> • Property Lines � <br /> • Centerline of street � <br /> • Outline and dimensions of all ezisting and • Indicate North <br /> proposed structures on the lot • Show any proposed grad�ng changes <br /> • Existing and proposed utilities � Show meesurements <br /> DO NOT WRITE BELOW THIS LIN[ � <br /> PERMIT CONDITIONS � <br /> 1.All calls tor Inspection shell be made 24 hrs.In advance•phone 259-8810. <br /> 2.All work shall be peAormed in eccordance with thia permit and curtent City of Everett Design and Construction � <br /> Standards and Specif(cationa <br /> 3.Call Locattan Underground Service 48 hra before you dig.TOLL FREE NUMBER 1•800�424-5555. <br /> � <br /> O <br /> pUBIIC WORKS PERMIT � <br /> NOT REpUIRED N <br /> BY <br /> OATE 3C O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City of Everetl from any and all ctaims lor dameges, costs, <br /> ezpenses, or ceuses of action that may arise because ol installation <br /> and maintenance of the improvement or other right•ol•way use hereto <br /> Approved lor Const�uction Date applied lor and furiher agrees to remove same upon notice from the <br /> City and to replace public property damaged thereby. <br /> FINAL INSPECTION Dale <br /> Approved as Constructed Signature of Applicant Date <br /> �� PUBLICWORKSDEPARTMENT WORK AU�HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarSlreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> ' Everett,WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8870 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 OAYS DURATION. <br />