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_... _ --."� <br /> �8te�� Puoec worb Pe�mil• <br /> Applicatlon For eiap.oso�.•� <br /> PUBLIG WC)I�KS PERMIT PuOTo�FeeFee s <br /> Less�oo�Fee P�id S <br /> Pflf11 Of Typ@ O�IIy eai�nce oue f <br /> ��n�qIL�YL 1� �x .��b E�E�rr ��2cb ��34- 151g <br /> Ownei Mailing F,ddress City Zip Phone <br /> 1 C���Snt ����I'a�(l►Vailin�ddress n. l-��� ]U�II . ZIq�?b Ph�]'7'0g�� <br /> Describe Proposed Work �� �u lll-�l ���., � �D� n�-�� �.� �/'[� �'] �" LJG1 � �l ) �� <br /> � `A�L�� <br /> W <br /> P�oject Address(if known) '— � <br /> Attach lour(4)copies of plans for pronosed work- Draw to scale and note th�lollowing as applicable: � <br /> • Property Lines • Centerline of sireet � <br /> O Ovliine er.)dimensions of all existing and • Indica�e North <br /> proposed Structures on the lot • ;how any p�oposed grading changes <br /> • Existing and propose�uHlities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> P[�iM1T CONOITIONS <br /> 1. All calls for inepection shall be made 24 hrs. in advance• phone 259•8815. � <br /> 2. All wurk shal. oe perlormed in accordance with this permit and current Ciry of Everett Design end Construction <br /> Standerds and Sprcifications. <br /> 3. Call Location Underground Service 48 hrs.helore you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> �U/3L/C �JO.G'f:S �r:�n��% it/oT ��C�U/.CEU /•j0/�7 O <br /> '�"�"`` � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold ar9 save harm- <br /> less the City of Everett irom any and all claims for damaU's, cosis, <br /> expenses, or causes of action that may arise becausa ^�' ,nstallation <br /> and mainlenanCe of ihe improvement or other righl•of�w>� use hereto <br /> applied for and further agrees to remove same upor no!ice Irom the <br /> � Approved for Construction Date City and to replace o�blic property dameged thereby. <br /> FINAI. INSPECTION Date <br /> Approved as Constructed Signature ot Applicant Date <br /> evr.rett PUBLIC WORKS DEPARTMENT WORIi AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSt�eet 1d0 UAYS OF DAT� PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PUFSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259-8015 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER�JO DAYS DURATION. <br />