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P�Ohcwo�Ms re�mn a <br /> Date_ '- <br /> , . Blay Dept� . <br /> Application For <br /> PUBLIG WORKS P�RPJIlT Fue•Io�FeeFee $ <br /> Lass AppL Fee Pa�tl 5 <br /> Baiexe o��� 5 <br /> �rint or Type Only <br /> Owne� Mailing Address �� <br /> City Zip Phnne <br /> , � . . � ' .— /�r.,r.r tla. .— - _ . . — <br /> qpplica�t :-� <br /> Mailir.g Address Ciry, Zip Phone <br /> �.� <br /> Describe P•oposed Work <br /> W <br /> Prolecl Address(if known) � � <br /> 0 <br /> Attach lour (�)copies ot plans br proposed work- Draw to scale and note lhe lollowing as applicablc: � <br />� ' • Property Lines • Centerline of slreet <br /> • Indicate North <br /> • OuUine and dimensions of all existing and � Show any prcposed grading changes <br /> proposed structures on the lot � Show measuremenls /� <br /> • Eaisting and proposed utilities W <br /> 00 NOT WRITE BELGVJ THIS LINE � <br /> PERMITCONDITIONS � <br /> 1. All calls for inspection shall be made 24 hrs. in advance- Phone 254•831 5. <br /> 2. All work�hall be performed in accordance wilh this permit and current City ol Evereu Design and Construction <br /> Standards and Specilicalions. � - <br /> 3. Call Loca�ion Underground Service 48 hrs. before you dig.TOLL FREE NUMBEF 1-800•424•5555. <br /> i; � <br /> � � r <br /> . . �.,�.i . , <br /> �' � �1 I� 1� /. �.' . <br /> � .�' pt- \a `� � � L� �, <br /> � <br /> i g F � <br /> �-S� ��'c f�;� � �� � ��� J �` P ��� � ��` -'` � � <br /> ,f , � , ,F F f �� �,,�' ia � <br /> [ l� ,� /� ,� l o ,� � 1 a <br /> i � <br /> � ����� Ga � ��/� �� n�s � ��� � „ � � <br /> � C <br /> � � �� �.� ,�� �e � ,�� ,;� r ��� ��� . � ,� � �. p. �: <br /> ,� � � � � � t� <br /> ' � '�� a y � ,P ,., F �' �' � Q� � < <' <br /> L � � / <br /> �v � _ <br /> �� �J /r - l �° Y 1� , � F`�p�` ; ��- _ <br /> �r ',:� P ,'' ,� Q� ; � <br /> ��,, ' � ��� I ACKNOWLEOGEMENTOFCONDI110NS <br /> � r', % � The undersi9ned ownedapplicant hereby agrees�o hold and save harm- <br /> r/ <br /> less Ihe City ol Everett irom any and all claims lor damages. costs, <br /> ezpenses, or causes o� action Ihat may arise because ol inslallation � <br /> and maintenance of the improvement or othcr righPoh�vay use hereto <br /> applietl lor and turiher agrees to remove same upon notice from the <br /> Approved for Construction �a�e City and to replace public property damaged �hereby. �� <br /> FINA�INSPECTION Date Dale � <br /> Approved as Constructed <br /> Signature ol Applicant <br /> WOR{ AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evere�t PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO ; � <br /> � 3200 Cedar Slree[ II 8� DILICENTLY �URSU[D TO CO�dPLETION. THIS PERMIT MAY B[ <br /> Everet6 WA 9821,1 ��El l �D Ll'i TH[ CITV UPON i.tJY STOPPAG[OF YJORK CN THIS <br /> Phone: ?59�8815 , C ��-'. 1 ��^ D�t�S UII�AT10'J. <br />