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...���[[[iQ/p �` ,� , <br />� Date%'/J�L � I PublicWo�ksPermits l� IG'� <br /> / � CiCn.DeF��+ <br /> Appl�cation For <br /> PUBLIC WOF3KS PEf�MIT ��°°°°°,°��_°°° - <br /> Tolal Fec $ <br /> LeSs AMPI Fee PT�� S- <br /> Balance Den S�i���� <br /> Print or Tyoe Onty -- <br /> .�i �P ��/iar� f�e�c�ers��� //6 � .�nlr�c�f✓ ��Ue�e7t- /�ao� <br /> Ow er Mailing Address Cily Zi Phone <br /> S�M% 355 B�S�g <br /> Applicant Mailing Atldress Ciry Zip Phone <br /> Describe Proposed Work J�J� �-ST � �� h `'� /00 � �onq <br /> �asS�?a �if,. /)��fc�i _ <br /> W <br /> Proiect Address(il known) ���� E. .Z�NTE2 C /T�� _ � <br /> Atlach four(4�copies of plans lor proposed work- Draw to scale ard note ihe lollowin�as applicable: � <br /> • Property Lines • Cenlerline of sireet /^ <br /> • Outline and dimensions ol all existinc�and • Indica;e North V� <br /> proposed slructures on the lot e Show any proposed graCing changrs <br /> • Ezisting and proposed U�ili�ies • Show measurements /�A <br /> �� W <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall 6e made 24 hrs.in advance-phone 259•8E{10. � <br /> 2.All work shall be pertormed in accordance with ihis permit antl currant City of Everet�Desic�n and Consiruction <br /> � Standardsand5pecifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLI_FP.EE PIUMBER 1-800•424-55b5. � <br /> O <br /> � <br /> � <br /> O <br /> � <br /> a <br /> ACKNOWLEDGGMENT OF COIJDf�IONS <br /> �f<C� Thr, undor;u�ned owner/applicant hereby ac�rees to hotd 2nd save harm- <br /> less the Gty ot Evere�t Irom any and all claims for damages, costs. <br /> '��r � eroenses, or causes ot actiun that may arise because of installation <br /> n �1 C f� �� and maintenance of the improvemenl or other right�of-way use hereto <br /> ` (D 2� � L� 1 T��- `-�/z�'/�� applied br and �urther agrees lo remove same upon notice irom the <br /> Approvetl lor struction �� City and to replace public properry damaged thereby. <br /> �/�f' // CW/L'[ `V � �,L4�A-'�— <br /> FINALINSP�TI N �� Date <br /> Approved as Construct=d Signat e ol Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STAR7ED WITHIN <br /> everetl PUBLICWURKSDEPARTMENT 180 DA'fS OF OATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar°treet BE DILIGENTLY PURSUED TO COMPI FTION. THIS PEFMR MAY B[ <br /> Everett,WA 98201 CANC[LLED BY THE CRY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�2G10 I 1=170JECT OVER 90 DAYS DURATION. <br />