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D8�@ � � /�, Pubht Wo�Ms Permit: _ <br /> Application Por eiao.o�o�.� <br /> PUBLIC WORKS PERMIT P�o�,<<,-��ksFe� <br /> .o�a�Fe� s <br /> �ess aoa�Faa Pam S <br /> Print or Type Only BaianceDue s_ <br /> �p117`'/1" D/roN/4� /`�'Lt lri�e. ,T7 fVc'/ZE�T 9�7-f�l <br /> Owner Mailing 4�lr.r�_:. City Zip Phone <br /> tiN�6n�,� coNsr, L � 1L��r�,,.w..� n•h ctir�acr,- rti� � zsL-9 ys� <br /> Applicant MailinpAddress Ci�y Zip Phone <br /> Describe Proposed Work �`�Mop��P L . N � t+ LL yfh•,�r _ � ' �e Sr / <br /> .� <br /> e�► 1�00 ^ s'f' e� -� r« !�'� K � PJ <br /> � .e / 2 Z . � �c,� «.•: t Ca S <br /> � s_3i o� � ~ W <br /> Prolect Address(il known) Z '� ' _ � <br /> Atlach four(4�copies of plans lor proposed work•Oraw to scale and note the follewing ns applicable: � <br /> • Property Lines • Centerline oi street � <br /> • Outline and dimensions of all existing a�d • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utiiities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for InsDection shall be made 24 hrs.in advance- phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current Ciry of Everett Design and Construction <br /> Standards and Specificztions. <br /> 3. Call Location Undergrountl Service 48 hrs.before you dig.TOIL FREE NUMBER �•800•424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> � less Ihe City of Everett from any and all claims for damages, costs, <br /> � expenses, or causes of action that may arise because of instaltation <br /> � ,27 g7 and maintenance of the improvament or other righhobway use hereto <br /> applied tor and furiher agrees to remove same upon notice from the <br /> ApproveA for Construction Date City and to replace public propery damaged thereby. <br /> —�7 � <br /> ,� �,'% ��G-� � �,�,, ��C'�.�[ s_�� -g � <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ot Applicant Date <br /> everett PUBLIC WOPKS DEPARTMENT WORK AUTHOti1ZED BY THIS PERIAIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS IS:UED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. 7HIS PERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJEGT OVER 90 DAYS DURATION. <br />