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Date�J�-�L�V " ` Pu�iic Works Fermlt a <br /> � Application For ame�oea�.. �a�� a�S�f <br /> PUBLIC WORlCS PERMIT Puoi�cwaksfee <br /> Total Foe S <br /> Less POOL Fee Paid Pu <br /> BalarceDuc $ <br /> Print or Type Only <br /> Lio�o4 .S1�kQs Z � Nl .,��e:�tf- !//� 9�'aa3 .�s��s� <br /> Owner Mailing Ad re City Zip Phone <br /> --�-�°' �� 1 I- <br /> Applicenl Mailing Address Ciry Zip Phone <br /> Describe Proposed Work �P �Pra 4 P <br /> �/– W <br /> Project Address(if known) ,��7rP M o � n n ��A J� � <br /> Attach four(4)copies oi plans for proposed work� Draw to scale 2nd note the lollowing as applicanie: � <br /> • Properry Lines • Centerline of sireel �A <br /> • Outline ard dimensions of all exis�ing and • Indicate Norih V� <br /> proposed siructures on the lot • Show any proposed�rading changes <br /> • Ezisting and proposed utilities • Show measurements M <br /> W <br /> DO NUT WRITE BELOW THIS LINE � <br /> FERMIT CONDITIONS <br /> 1.All cails lor inspection shall be made 2A hrs.in advance•phone 259•8810. w <br /> 2.All work shall be peAormed in accordance with this permit and wrrent City of Everett Design and Construction ♦ <br /> � Standards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.70LL FREE NUMBER 1-500•424•5555. � <br /> ��Ci(�c C(,OLlia. J��i���c-��/�a��/'–G�. O <br /> //L/�'_ �O�'`� � <br /> 5//90 N <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees lo hold and save harm• <br /> — less ihe City ol Everetl trom any and all claims for damages. costs. <br /> ezpenses, or causes ol adion that may arise because of installation <br /> and maintenance of ihe improvement or other right-of-way use hereto <br /> applied for and further agrees lo remove same upon notice irom Ihe <br /> Approved for Consir�c�ion Date City and to replace pu�lic properry damaged thereby. <br /> FINAL INSPECTIQN Date <br /> Approved as Constructed Signature of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED 'JJITHIN <br /> everett PUBLIC WORKS DEPARTMENT 7g0 DAYS OF DATE PERMIT IS ISSUED AND 7HEREAFTEF IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSU[D TO COMPLETION. THIS PERMIT M4Y BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 pFOJECT OVER 90 DAYS DURATION. <br />