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�8te /�A L . PuDlic Wak�Permll• O�'`�o <br /> ' � BIOp.Oept r <br /> � � Applkatlon For <br /> PUBLIC WORKS PERMIT FueTot�FeeF� : <br /> Les�Appl Fee PUa 5 <br /> Print or Type Only B�I�ncelNe f 2�� <br /> ,��x�JA�eo .��� .�82�-I�8'N 7�[cJ. �Y.CWl,rXioL> �Bo3�� 75�2-S4 f�,L <br /> Owner MaiNng Address Gity Zip Phone <br /> �Es/NotOSLi�y ING• /U��S-�VE. /20� ��i�GA�.I�'� �2/— 6068 <br /> 7Applicent� Mailing Address City Zip Phone <br /> Deacribe Proposed Work ��y-rT�PlK1 NE�d SiNGLE FA��- .PES. <br /> , , ��- ar W <br /> P•o�ecl Addreas(If known) 2.� ��'CA � k� L � <br /> C..�C-F,is:bo�E NEiGN <br /> Attech tour(4)copies ot ptans for proposed work• Draw to scale and note Ihz tollowing as applicable: � <br /> • Proparty Linas • Ccntedine of street � <br /> • Outline and dimensions of all existing and • !ndicate Nort� <br /> proposed structures on lhe lot • Show any proposed grading changes <br /> • Ezintinp and proposed utilities • Show measurements � <br /> � �O NOT WRITE BELOW THIS L�NE <br /> PERMIT CONDITIUNS � <br /> 1. All calls for inspectlon shall be made 24 hra in aovance-phone 2'.7'9•88'I 5. � <br /> 2. All work shell be pertormed in accordence with this permit and wrrent Ciq�of Everett Design and Construction <br /> Stendards end Specifications. � <br /> 3. Caf ;.xatv,� Grdeyr.-unc Sr:c�ce 46 hrs.beforo yr.0 dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> PCKNOWLEDGEMENT OF CONDITIONS <br /> The undersigne�f owner/applicant hereby agrees to hold and save harm- <br /> less tne City ol Everett iron: cny a:d all claims for damages, costs, <br /> eapenses, or ceuses of action fhat may arise because of installation <br /> � / /�_�� ��0�8H and mainter,ance of the improvement or other right-ot�way use hereto <br /> it.6i Jif <br /> applieJ for and further agrees to remove same upon notice irom the <br /> Appro�onstruction� � Date City and to replace public property damaged thereby. <br /> �� ��=�— �- 7- � -��l �� � 3- 7- e�6 <br /> F�T lAL INSP CTION Date �� <br /> 6 <br /> Approved ea Constructed " Signature of Appli ant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZEO DY THIS PERMIT MUST BE STAFTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />