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� . _- --_ ___---_--_-- _ _. �.,..,. �.,. _ �..w�,. _ _ _�_ .�. �. <br /> -�,�..� _�_. _ . . <br /> �'''- Appliwtlon For DatC-;� V_/_ • � <br /> PUBLIC WORKS PERMIT <br /> Public Works Permit k <br /> PUBLIC WORKS DEPARTMENT / <br /> Everett, WA S 201a(425)257-8810 Building Permit p C WZ102 � <br /> TYPE OR PRINT ONLY Public Works Fee� <br /> �i o �c ,�o w���� i 7,3! ,�a�.�� S; �'zQ� - ,�s' .z�iv� <br /> Owner Mailing Address City Zip Phone <br /> 1Scl7.-�,� 'o��/�tsic� /�3J—� fl,� y� .1•�Q1�i�dicL� �;�e a��1�0 <br /> --App�nt Mailing Address Ciry 2ip Plrone <br /> Describe Proposed Work �����/ �� e� ��L� ��U�" � <br /> -Tb 1 �� ��5� � � � ��c� � S -� c� �i-�;,�' �' <br /> �rt.y ��1�2 -��—rJ�rC 3 �" � <br /> PROJECT ADDRESS (if known) �z� f �� f'/i�� / � �/t i � <br /> Anach four(4)copies plans lor proposed work-Draw to scale and note the following if applicable: � <br /> •Property Lines •Outline and dimensions of all existing and pmposed structures on the lot •czistlng and proposed utilitles � <br /> •Centerline of street •indicate North •Show any proposed grading changes •Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS: O <br /> 1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br /> 2. Ail work shall be performed in accordance with this permit and current City oi Everett Design and � <br /> Construction Standards and Speci(ications. . <br /> a. Call Location Underground Service 48 hrs. betore you dig.TOLL FREE NUMBER 1-800-424-5555. ♦A <br /> V♦ <br /> ;'UDLIC WOqKg �ERMli O <br /> bOT J3,�:C:UIqr� A <br /> p� 1■V <br /> :Y�...W�'✓ 1�q �: <br /> RA7E__......,..C� "�,�..�. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownerlapplicant hereby agrees to hold and save harmless <br /> the City of Everetl irom any and all claims for damages,costs,oxpenses,or <br /> pprove or ons n;c ion a e causes of action that may arise because of Ins ation and maintenance o(the <br /> improvement or other right�of•way use heret Ifed for and further agrees to <br /> remova same upon notice irom the Cfly replace Iic property dam- <br /> aged y. � 1 � — � <br /> FINAL INSPECTION Date <br /> Approved as Construded <br /> n re pican a <br /> WORKAUTHOR�DBY7HISPERMfTMUSTBESTAHTEDWIh11N180DAYS ATE RMRISISSUEDANDTHEREAFfERISTOBEDIUGENRYPURSUEDTO <br /> COMPLETION.THIS PERMR MHY BE CPNCELIFD BY7HE CfTY UPON ANY AGE OF WORK ON THIS PRQIECT OVER 90 DAYS WRA710N. <br />