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Date �/'� " �� PuOiic Wo�ka Permit• ��" / <br /> Appiiwtion For eioo oso�.• <br /> PUBLIC WORKS PERMIT °°°°°W°�.F°° <br /> Toi�l Fee s <br /> LefMppl Fee P�iO s �/ <br /> 8�1�nte Due s �� �„•���. <br /> Print or Type Only <br /> �/ i ✓n�P� �a n N r r�f <br /> �J��^� �`nv�rs-�q�„i-�_,-��/ �ivi� ��r L=v�rr� 9�P�D1 ��39-ih7�5'/ � • <br /> Owner MaiNng Add�s City Zip Phone � <br /> � �j+� e <br /> Applicent� Mailing Address City Zip Phone <br /> --� !/ " <br /> Describe Froposed Work � <br /> �-.!�� /-_�I //�._�-� � � r���' + <br /> �-`�d-�f��"' ��frc� iiiG�, "� v's'�v�� /`, <br /> Project Address(il known) _I.�G�p^ /yQc✓.7T� f/✓(' � <br /> � <br /> Attach four(4)copies of plans for proposed work• Oraw to scale and nole the fotlowing as applicable: � <br /> • Property Linas • Centerline ol street � <br /> • Outline and dimensions of all existing and • Indicate NOAh <br /> proposed structures on the lot � Show Any proposed grading cnanges <br /> � Existing and proposed utllities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shell be made 24 hrs.in advance-phone 259�881 O. � <br /> 2.All work shell be peMormed in eccordance with this permit end cuRent Ciry of Everett Design end Conatrudion <br /> Stendards and Specilicationa. <br /> 3.Call Location Underground Service�rs.before you dig.TOLL FREE NUMBER 1-800�424•5555. � <br /> � <br /> �' � ` '��q`' " ' 0 <br /> �,�f � � <br /> ��r� A /lF� �-�-�Z � <br /> ' � <br /> � o <br /> �Cc�S��� TN9,✓ /8 � /� PntS/dLC. a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/epplicant hereby agrees to hol�1 and save harm- <br /> — less the City ol Everett Irom any end all cleims for damaqes, cosls. <br /> ���c�_ expenses. or causes of action that may erise becauae of instellation <br /> 8����, and maintenance of the improvement or olher riqhhof•wsy use hereto <br /> applied lor and further agrees to rem same upon nolice irom the <br /> Approved for C$nstr ion a�e City an o replace public pr�e ty maged thereby. <br /> y <br /> :' Gy.�.._.�"�� r.�D .,y - , �' � � <br /> FINAL INSPECTION D te � - � . . <br /> ' Approved as Constructed Signature ol Applicant <br /> � PUBLIC WORKS DEPARTMENT W�RK AUTHORIZED BY THIS PERMIT MUST BE STARTED� ITHIN <br /> 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO . <br /> Everett,WA 98201 BE DIIIGENTLY PURSUED TO COMPLETION.TMIS PERMIT MAY BE <br /> Phone:259-BB70 CANCELLED BY THE CITY UPON ANY STOPPA6E Of WORK ON THIS p <br /> PROJECT OVER 90 DAYS DURATION. <br /> i <br />