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\ , 1-.� <br />Date�'� 1��7 <br />Application For <br />PUB�IC WORKS PERMIT <br />Print or Typa Only <br />� ^) � <br />App�icant <br />�� <br />Address <br />�escribe Proposed Work % � C-h'�t� ��'—� ��Q-�`a�`� <br />Prolect Address (il knov:n) <br />� , �:. ...�- <br />— y--�/ <br />� � <br />. ,c, oen� • — ��,I� — <br />Puo�¢wo�kaiea 5 <br />Tola1 Fee — <br />L¢!f ApO�� FCe Pa.a 5 <br />BalanC¢ Du0 5 <br />�� - �.1 %� <br />Zip <br />Zip Phone <br />Attach lour (4) copies of plans lor proposed work - Draw to scale and note the lollowing as applical�ie�. <br />• Proper�y Lines • CenlerPne of slree� <br />• Outline and dimensions ol all ezisling and • Indicate Norih <br />proposed structures on Ihe lot • Show any proposed gradin9 chan9r; <br />• Exisiing and proposed ulilities • Show messuremenis <br />Pi�L•ll�� <br />P[qM1T CONDITIONS <br />t. All calls for inspection shall �e made 2a hrs. in ad��ance � phone 259-881 5. <br />2. All work shall be performed m accordance with ihis permit and current Cdy of Everett Design and Construchon <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. bebre you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� ', , <br />hoprevetl �Or COnSbuCliJn <br />_ <br />���;_��.... ./;�,�>�,�:. :� . . . ���_ . _ . . <br />� <br />O <br />�w <br />_ I <br />� <br />a <br />ACKNOIVLEDGEM1IE�T OI' CONDITIONS <br />l ht� undersi9ned owner/epplican� hereby 2grees lo hold and save hnrnr <br />-- — Irss the Gty ol EvereU trom any and all claims lor damages. cosL:. <br />ext�enses. o� causes ol action Ihat may arise because ot in;t;illation <br />:!nd maintenence ol Ihe improvement or olher righl-obw:vy usc hmF�to <br />;�pplied lor and lurther agrees �o remove same upon nohcc hom thc <br />����' City and lo replace Pu61ic property damaged Ihereby. <br />FINAL INSPECTION Date <br />Annroved as Consiructed � <br />���.i.�i��� PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />EveretL WA 9B201 <br />Phon^�259-8815 <br />Signature of AppllcaM ���0 <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTFD WITHiN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEH IS TO <br />BE DIUGENTLY PURSUED TO COMPLETION. THIS PEHMIT F,1AY BE <br />C�NCELLED B1' THE CITY UPOPI ANY STOPPAGE OF WORK ON THIS <br />PROJEGT OVER 90 DAVS DURATION. <br />