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t <br /> Puouc Works Pe�mil• D���� � <br /> D8i9 � �U eiac.oea�.• <br /> Applicetion For <br /> '� WORKS PERMIT P�����worNaFee s <br /> � PUBLIC TotalFee <br /> � �ess AOP�-Fea Pa10 s <br /> eelance Oue S '�n� <br /> Print or Type Only �<_�3 -�i 7Z <br /> � ? . - � ' -'L � -' ZcX� <br /> ' - �/�! � -� � _ ' � � Phone - . <br /> ' MaiNng Address ���Y Z�P / <br /> ' Owner . . . � --�7SC� . <br /> ' _ "��c[,_ - �i �;o?�, :' (i - -G <br /> TLs' T �✓� Zip �-. �--PAone L/C' <br /> Applicant MailingAddress ���Y � v�>S'�SS <br /> { .�is��� <br /> � <br /> ' — 7 � /� .� � } i� � <br /> i ,E./ , '� <br /> Deatribe Proposed Work , <br /> ' � ., . H; / �/���C � �+EJ�c� ..n <br /> x <br /> � ' � <br /> ' W . <br /> �, >���,i - I� ; <br /> � Prolect Address lif known) . � <br /> � Attech four(4)copies of plans for Droposed work• Draw to scale and note�Ceniterline ot stPee't able: � � <br /> • Property Lines • InAicate Norlh <br /> , • Outline and dimensions of all exisling and � Show any proposed grading changes � <br /> � proposed structures on the lot � Show measurements � ; <br /> • Existing and proposed utililies <br /> DO NOT WRITE BELOW THIS LINE O �; <br /> � PERMIT CONDITIONS � . <br /> 1.All calls tor inspection shall be made 24 hrs.in advence-phone 259�8810. <br /> � 2.All work shall be pertormed in eccordnnce wflh thls permit and curren;Cily of Everett Design and Construction <br /> i Standards and Specifications. � ' <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800�424•5555. <br /> '� . �UOr.� �a B� o�o�e �' er az�acifed �a«i�/�r O � <br /> J' c41� � ;��s,o�c�dr- �4,-d��'2 ���c✓� �z�'.w � '. <br /> �2 t///!G'. ` <br /> � O , <br /> � <br /> a ` <br /> ACKNOWLEDGEMEN'OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• � <br /> less the City of Everett trom any and all claims for damages. costs, <br /> �— expenses, or causes of action lhat may arise because ot installation i. <br /> r � a3 and maintenance of the improvemenl or other right•ohway use hereto <br /> applied lor and further agrees to remove same upon nolice trom lhe <br /> j Date Ciry and to r lac�blic properry damag\thereby. <br /> Approved for Consl uctio = �\ � <br /> 3� "�/ ` �—� = � <br /> FINAL INSPECTION Date ��— . � Date <br /> Signature of APP��� " <br /> Approved as Constructed WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CederStreel 8E DIUGENTLY PURSUED TO COMPLETION.l41S PERMIT MAY BE � <br /> � Everetl WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8810 PROJECT OVER 90 DAYS DURATION. <br />