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Date_�J L_G� Public Works Parmit� /D 6 <br /> / Application For ema-oeai.e <br /> PUBLIC WORKS PERMIT P°°°°W°,k,Fa° <br /> ro�ai Pee S �UU —�� <br /> Lees Appl Fae Pe1E .S� <br /> Belance Due S � <br /> Print or Type Only <br /> ,ke� ,Dai�f� 2339-//th.�v� E�st S�ntf/e, Gl��. 9B/aZ 3zz-6s¢z <br /> Owner Mailing Address City ZiP Phone <br /> ���in 8• Fi-i e� P 0. Box 2� , �vei-er�� Gl/q. 9.R2%� ZSz-87.3¢ <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work J ���� ���`�V�����h� �� a/'s �!°.�„,PO��%� <br /> �-i ./�./� � Q6 -/G rr6 , C�6 , 6�rff���ii�/Si' �u.�/,E .o�h /,�c i9B6. <br /> Project Address(if known) 2Z2� Ereie , /Y�Y� � <br /> � <br /> Attach four(4) copies of plans lor proposed work• Oraw to scale and note the following as applicabie: � <br /> • Property Lines . • Centerline ol street � <br /> • Outline and dimensions ot all ezisting and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cails for inspection shall be made 24 hra in advance• phone 259•881 5. � <br /> 2. All work shali be performed in accordance with this permit and current City of Everelt Design and Construction <br /> Standerds and Specifications. <br /> 3. Catl Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> � �- ���-�, .�.����s ��� � �/�'-�7 � <br /> � <br /> � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersic�ned owner/applicant hereby agrees to hold and save harm- <br /> � less the City ot Everett irom any and all claims lor demages, costs, <br /> expenses, or causes of action thut may arise because ot installation <br /> Ze Q and maintenance of the improvement or other right-ol-way use hereto <br /> applied lor and luriher agrees to remove same upon notice from the <br /> Approved I truction Date City and to replace public property damaged thereby. <br /> . ^l/�_� j� � �!'C�-C.Y•�// G��� <br /> INAL INSPEC ON Date <br /> Approved as Consiructed i ignature of Applicant a�e <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHOR�ZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Siree[ BE DILIGENTLY PURSUED TO COMPL[TION. THIS PERtv11T MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259:�IIS�S$OC� PROJECT OVER 90 DAYS DURATION. <br />