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�at@� � ''�'i Pu�l¢Works Varmn i <br /> Application For Blep.�e0����� <br /> PUBLIC WORKS PERMIT PuDToialFeuFee s <br /> Less Aoo�Fee Pe�e S <br /> Print or Type Only Be�a��eo�a s <br /> �RNIY_ JONNSJ�[ 7ZZJ DLYM��C. D� �✓�ZEiT q8Z0� .�Stj'G�I(�rJ <br /> Owner Mailing Address City 2ip Phone <br /> .�F1-F 1-�cILMA�/ 7�Z5 63Q� s'; Fv,E,2c,7 9lLo3 353-y482�154•BP// <br /> AppliCant Mailing Address City Zip Phone <br /> DascribeProposedWork Z 'Si��Y W�aO ADO�TiuAl /Z' tZo' <br /> W <br /> Pro�actAddress�ifknown� 7�.Za OLYM/�lC �R FVE�2CTT � <br /> Atte�:h tour(4)copies of plans for proposed work-Draw to scale and note the foltowing as applicable: � <br /> • Prope�ry Lines • Centerline ol sheet �� <br /> • Outline and dimensinns ol all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 hrs. in advance• phone 259•8815. � <br /> 2. All work shell be performed in nccordance with this permit antl current City of Everett Desigii and Construction <br /> Standerds end Specifications. <br /> 3. Cell Location Underground Service 4B brs. before you dig.TOLL PREE NUMBER 1-800•424•5555. � � <br /> .UO �v��� u.�.�ts' �.e�T .r^E,�v�,eE-O /-7-8� O �, <br /> `� � <br /> � <br /> O <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and s3ve harm• <br /> less the City ol Everett from any and all claims for damages. costs, <br /> expenses, or causes of ao�.,n that may arise because of !nstallation <br /> and maintenance ol the imprevement or other right-ol-way use hereto <br /> Approved lor Construction Date applied for and further agrees to remove same upon notice Irom the <br /> City and to replace public properry damaged thereby. <br /> FINAL INSPECTIOR� Date � ��7�8� <br /> Approved as Constructed Si n�l ol Applicent �ale <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAVS OF DATE PERMI7 IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCEIIED BY THE CITY UPON ANY STOPPAGE OF WORK ON 1HIS <br /> PROJECT OVER 90 DA�'S DURATION. <br />