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DateJQ�( �1 /"—r PubLc Woiks Permlt� <br /> / � / � <br /> Appliwtwn For eiea.oeo�.+ S7 /P / 2 <br /> PUBLIC WORKS PERMIT PuollcWorksFeo � <br /> To�a�Fao s <br /> Lesa ApO�Fee Paitl s <br /> Print or Type Only Baianceoue S <br /> ,�_�/C /ro,D/�//!S /.��.3 �J�.t'es �?,�iic cG�r.c'e�T %�ao/ a�z- y'y�> <br /> Owner Mailing Address City 2ip Phuue <br /> Gczd� �� s�-�� ii ;�A��hc �,rsr��.�s , s�s � s;�r->-�� � <br /> Applicent Mailing Address Cily Zip Phone <br /> Describe Proposed Work 7�'�C �D 4iil C K/ST�`5� aC X 3d ��/� <br /> _��LrcN ��O R a�1 G/.�,c'r'.- <br /> Pro�ect Address(it known) / .� Z 7 �����.�.� � <br /> Attech four(4)copies of plans for proposed work• Draw to scale and note ihe following as eppliceble: � <br /> • Property Llnee • Cente�Nne of street � <br /> • Outline end dimensions of all existing and • Indicate North <br /> p�oposed atructures on the lot • Show any proposed grading chenges <br /> • Existing and proposed utilitfes � Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PEFMIT CONDITIONS <br /> 1. All cefls for Inspectlon shell be mede 24 hra in advence• phone 259•881 5. � <br /> 2. All work shall be peAormad in acwrdance with this permit and current Ciry of Everett Design and Construction <br /> Standards end SpecillceNona <br /> 3. Call Locetion Underground Service 48 hra before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> P//f�G/C G�/C•2.�s �F�c.�/n:T ,tJcT� .C'rcfGi.e�,p O <br /> lo—/O —B? <br /> �� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett irom any and all claims for dameges, cosis, <br /> expenses, or cauces of action that may erise because of installalion <br /> and maintenance of the improvement or other right-of•way use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> Approved for Construction Date City and to replace public property damaged therr,ay. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ot Applicant Date <br /> evere[t PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Sireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl.WA 98207 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />