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Date.�D ���;,�<wo„s P�,m�.r=��?_}� <br /> Appliwlion For Bicd %eo�.•� -/�-lt_.LT <br /> I <br /> PUBLIC WORKS PERMIT °°°1i0PJ015Fee <br /> Total Fee $ <br /> LC55 AO���FCC Pdid wS <br /> �alanre�ue $ <br /> Print or TyFe On!y <br /> ►2r`�l�.i�,V'��J r?�x-I �A���� �,l,�Y�,� � -��--3 8C�3 <br /> wner Mailing Address City Zip Phone <br /> qPp--r �j�a�� Mailing Address City Zip Phone <br /> DesCribe Proposetl Woni ` r +y� �, t — <br /> � 1./^'n W <br /> PrajectAdtlress�ilknuwn) _ `L I �—�—� � <br /> A�tach lour(4)cepies o7 Wans lor proposed work� Draw to scale and note the following�s a plicable: � <br /> • Properry Lines • Cenlerline o�street � <br /> • Outline ard dimensions of all existing and • Indicate Norih <br /> proposed st�ucture.;on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Shov.�measuiemenis /M <br /> W <br /> GO NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> 1.All calls for inspection ahall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBEfi 1-800•424•5555. �/ <br /> ' l.! , �� � � ��1 1 <br /> � 7�-/�ge �.� <br /> `1�� � <br /> v� <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersi9ned owner/applicant hereby agreas to hold and save harm� <br /> less the City ot Everetl irom any and a�: claims lor dariages, costs, <br /> expenses. or causes of aclion Ihat may arise because ol installation <br /> and maintenance ot ihe improvemenl or other rlghbo(-uvay use herefo <br /> applied for and (urther ag�ees io remove snme uport notice Irom ihe <br /> Approved for Construction � Date City and to replace public property damagetl th=reLy. <br /> FINAL INSPECTION Date — <br /> Approved as Constructed Signature ot Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORNS DEPARTMEN7 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everei�,WA98201 CANGELLED BY THE CITY UPON ANY STOPPAGE OF WORK GN THIS <br /> phone:259�8C10 PROJECT OVEH 90 DAVS DURATION. <br />