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Date.���a a,�w�r,wo,ks ae�m�i. 2[ .._ <br /> Applica�ion For em�.oeoi._ __����0.5-- . <br /> PUBLIC WORKS PERMIT P°°'�°W°«=��a -- --- <br /> ro,T�F�� s_— <br /> Less Ano�.Fec Paia S -- <br /> Balance Ouc $ <br /> Print or Type Only -- <br /> ,-� �l �J 1�r�6 Lr�r�-hr, �r� �C�P ,P /-f- q�'za/—��– �:� �s <br /> Owner Mailing Atldress City 2ip Phone <br /> �,�G �:nA\ '� �?�� ill�(�� ��.✓nl��r_� �I-7�5� <br /> Applicant � Mailing Address City Lp Phone <br /> Describe Proposed Work !(#�L—��� /l �m��b f P Ili^�ALI f � <br /> W <br /> Project Address(if known) __ � <br /> Atlach lour(4)copies of plans lor proposed work- Draw to scale antl note Ihe tollowing as applicable: v <br /> • Property Lines • Centerline of sireet ♦^ <br /> • Outline and dimensions of all existing and f Indicate North V� <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Exis�ing and proposed utilities • Show mensuremenis � <br /> 00 NOT WRITE BELOW THIS LINE o � <br /> PERMIT CONDITIONS <br /> 1,All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Desiqn and ConsVuction <br /> Standards and Specilications. <br /> � 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> � / � rI <br /> G`� /� L�'G%/��� (� <br /> � Z� ,r^ <br /> /` ` V♦ <br /> , l' ,�j <br /> O <br /> � <br /> ACKNOWLFDGEMENT OF CONDITIONS <br /> The undersigned owneqapplicant hereby agrees to hold and save hann- <br /> — less the City of Everett irom any and all claims for damages, costs. <br /> expenses, or causes of action that may arise 6ecause of inslallation <br /> and maintenance of the improvemen� or o�her righbol-way use hereto <br /> applied tor and lurther agrees to remove same upon notice (�om �he <br /> Approved for ConsVuction �a1e Gity and to replace public properry damaged lhereby. <br /> FINAL INSPEC'-ION Date <br /> .4pproved as Gonstructed Signature ol Applicant Date <br /> WGRK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everet[ PUBLIC WORKS DEPARTMENT 18D DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Sireet BE DILIGEIJTLY PURSU�D TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 94201 CANCELLED BY THE CITY UPOIJ ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />