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Date�'��� ` PUEIic Works Permit•cJ/ �� —p�q��� <br /> Applicatlon For Biag.oeoi.•____O 5���_ci.Ll..__ <br /> PUBLIC WORKS PERMIT PUEiicWorxaFee s -- <br /> Tclel Fea <br /> Less AaO�Fea Pa�C S <br /> Prirt or Type Only ea�a���o�e S Z_OQ�— _ <br /> Jc.� ��...� �/`/0�. (',.� �,��.. �� 1�:�v3 �%� 3.�� <br /> Owner Mailing Address Cily Zip Phone <br /> (���,:��.o,�� )�",� � �/Yo� ��u„J f . . � %'�a o3 �� y� z.�,a <br /> Appliaant Meiling Address City Zip Phone <br /> I r r <br /> Describe Pronosed Work /1�Gad . �.���T4,�,, /.� �� <br /> E�9s r W <br /> � � / � <br /> Project Pddress(if known) 2����. � <br /> Attach four(4)copies of plans lor proposed work•Draw to scale and note the tollowirg as applicable: � <br /> • Property Lines • Cen�erline of siree� � <br /> • Outline and dimensions of all existinn and • tndicate No�th <br /> pto�osed sfructures on the tot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITt BELOW THIS I.INE O <br /> PERMIT CONDITIONS <br /> 1. All cails lor inspection shall be made 24 hrs in advance-phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specilications <br /> 3. Call Loca�ion Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1-$�0•42�•$555. � <br /> O i <br /> � I, <br /> � ; <br /> O <br /> � <br /> ACKNOWLEDGEMENi OF CONDITIONS <br /> The undersigned owner/applicant hereUy agrees to hold ano save harm� <br /> — less• lhe Cily of Everett irom any and all claims lor damages, costs, <br /> . eznenses, or causes of action that may arise because ol installation j <br /> '�' � � and maintenance ol ihe improvement or o�her righl•ol-way use hereto I <br /> � ` '� ,C��'�� 3 y �� applied tor and h � a5"=as to remove same upon notice Irom the <br /> Approve tor on troction z � Date City and re blic pr perty damaged ther <br /> �-2�� � <br /> —� � <br /> FINAL I PE ION Date ��6 <br /> Approved as Constru ed Sign w� Applica � Date <br /> everett �UBLIC WORKS DEPARTMENT WO K AUl'HOAIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA 98207 BE DILIGENTLY PUFSUED TO COAIPLETION. THIS PERMIT MAY BE <br /> Phone:259�8815 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />