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� <br /> � Prbllc Warks Pmmit• <br /> Date � z ����� <br /> emy.oao+.r <br /> Appl�cation For <br /> PUBLiC �ll/Q:�KS PER�vIIT PUElitlVorFSFce � __ <br /> TalelFre <br /> Lasf AppL feo PeiE g—� p <br /> Balan:e[Iue $ 1 <br /> Print or Type Only <br /> I1 "^ 1 /_/' �//.�I � S�4'/-c`'/ �!5'-i°' , .?.5.�- -i�,-1. y <br /> ��� i��� C��Q ��:����b .� ,� �'� ��C (��/ ���c,�i. .4 a� <br /> Owner Mailing AddresS Ciry ZiP Phone <br /> ��/�'%�/ <br /> �,pplicant Mailing Address Ciry Zip . Phone <br /> DescribeProposedWork l� �. f'�x �.�_ ��r ��� - - <br /> _— — � <br /> ..�N-i.s4 .4 � :ic_�Ne,� � <br /> Project Address(if known) , <br />� Atlach four(4)copies of plans for proposed work-Draw to srale and note the lollc Hing as applicable: � <br /> • Property Liaes • Centerline ol street � <br /> • OuUine and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grcding changes <br /> • Ezisting and proposed utilities i Show measurements /� <br /> W <br /> DO NOT WRITE BELOV�THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. All calls for inspeclion shall be made 24 hrs in advsnce-phone 259•881 5. � <br /> 2, All work shall be pedormed in accordance with this permit and current City of Everett Design and Consiruction <br /> Standards and Specilications. <br /> 3. Call Lowtion Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> ��y � � <br /> o� <br /> b\�� � e5`����� � <br /> � � <br /> �� Q'� ,� ��`i <br /> � ��- �� � <br /> Q � � o. <br /> ;� <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned oxner/applicant hereby agrees to hold and save h:.rm- <br /> less the Giry of Everelt from any antl all claims tor damag�s, costs, <br /> expenses, or cause:: ol action that may arise because of installation <br /> and maintenance of ehe improvemenl or other righ4obw:.y use herelo <br /> applied lor and luriher agrees lo remove same upon notice irom tho <br /> Appioved lor Construclion Dale City and tc replace putlic prnper:y damaged Ihereby. <br /> • .� <br /> FINAL INSPECTION Date Date <br /> Approved as Constmcted Signalure of Applicanl <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLI.^,WORKS DEPARTMENT 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAF7ER IS TO <br /> � 3200 Cedar Slreet BE DILIGEN7LY PURSUED 70 GOMPLETION.THIS PEFiMIT MAY BE <br /> Everett,VJA 98201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone:259-8815 pROJECT O'JER 50 DAYS DURATION. ) <br /> i � <br />