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0'atQ�� � PUCI¢Worke Perm t a /p <br /> Applicalion For eiae Deo��•_ JD�/ — <br /> PUBLI�� WORKS PERMIT P°°°°W°«•�°° <br /> Toiai Fea s <br /> Lea�Fopl.Fee Pe�E s <br /> Print or Type Only BaianceDue s <br /> i�,rl ro.� �-r��x�ke �„��_�oG Me�c.la�veir r� 4P Zo i as z-nzZ� <br /> Owner ai{ing Atldress dy Zip Phone <br /> Sil✓plfal�e ��ri�� aq3� F„�ti.,, Eve�etf- }�zo6 zsz- l13 / <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work f/{�(���T y� r P Si 0le�Q <br /> W <br /> Prolect Address(il knorm) � <br /> Attach four(4)copies of plans for proposed work- Oraw to scale and note the following as applicable: � <br /> • Property Lines • Centerline oi sfreet � <br /> • Outline and dimensions of all ezisting and • Indicate tJorih <br /> proposed structures on the lot • Show any proposed giading changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NOT WqITF BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t.All calis for inspection shall be made 24 hre.in advance-phone 259•881 O. � <br /> 2.All work shall be peAorm�d in acwrdance with this permit and wrrent Ciry of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Cell Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-600•424-5555. � <br /> /�1��?liL GJa��s �',�,��iT �i�rr f, 'GnG���.�p O <br /> c�� <br /> � <br /> a/i�/AB N <br /> O <br /> a <br /> �CKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applican�hereby a�rees to hold and save harm� <br /> — less ihe City ol Everett Irom any and all claims for damages, cosls, <br /> ezpenses. or causes ol aclion that may arise because o: installation <br /> and maintenance of the improvement or other nghbol�way use hereto <br /> applied for and turther agrees to remove same upon notice I�om ihe <br /> Approved lor Construction Date C�ty and to renlace puU6c propertY damaged Ihereby. <br /> FINAI INSPECTION Date <br /> Approved as Consiruded Signature ol Applicanf Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHO(iIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND TIIEREAFTER IS TO <br /> Everett,WA 98201 B[ DILIGENTLY PUFSUED TO COMPLETION. THIS PERfd1T MAV BE <br /> Phone:259�8810 GANCELLED BV THE CITY UPON ANY STOPPAGE OF N'ORH ON THIS <br /> PROJECT GVER 90 DAYS DURAiION. <br />