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`— X/� J <br />� �8T8��v PuGlic Worke Per 0 t v J G�/ � <br /> AppllcatbnFor BItlp.Dept.• �,��� 5�..3.��7 � <br /> ; PUBUC WORKS PERMIT PueTolalFaeFee , <br /> 4' <br /> Lefe Appl Fee Pald s _ <br /> �� Balarca Dun S �� <br /> t, Print or Type Only <br /> i. �77�7- <br /> r <br />: I /�1 ` � <br /> f. I�A,J �itJEce[4F-kE ��o9Q5�-��rr�� �liJoNOMIJH 33'f- S�l/3 <br /> i� Owner MaiVing Address City 7ip Phone <br /> v�rn�_ ,�� <br /> Applicant Mailing Address City 2ip Phone , <br /> Deatribe Proposed 1Vork �F� — <br /> - W <br /> Project Address(il known) �2�[� —" �77a�G�' -fr � <br /> Attach tour(4)copies ot plans for proposed work- Drew to sca�e and notz the following as applicable: � <br /> � Property Lines • Centerline of street � <br /> • Outline a�d dimensions of all e•isting and • Indicate North <br /> proposed strudures on the lot • Show any p�oposed grading changes <br /> • Exisli�g end proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMII'CONDITIONS <br /> 1. Ail calls tor inspection shell be made 24 hrs. in advance- phone 259•8815. � <br /> 2. All work shall be performed in accordence with this permit and current City ot Everett Design and Construction <br /> Standeids end Specifications <br /> 3. Call Locntion Underground Service 48 hrs. before you dig.TOLL FREE NUMDER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> � �.,�sPEc��� 0 <br /> ° ` �'�a���s'�° a <br /> I ACKNOWLEDGEMENT OF CONDITIONS <br /> t The undersigned owner/applicant hereby agrees to hold and sa�e harm- <br /> less the Cily of Everett trom any and all clalms for damages, costs, <br /> �^// ezpenses, or causes ol action that may arise because of insta�lation <br /> � y� sPG /J 0�,../�� and maintenance ef the improvement or other right•oFwey use hereto <br /> �� �'���-y ,� <�� applied lor and further agrees to remove same upon notice trom the <br /> Approved for Con �uction ate City and to replace public property damaged thereby. <br /> FINAL INSPECTION �a�e /��.f��i� Y�"�� <br /> Approved as Constructed ignatur of p ant Dale <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND 7HEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.TiiIS PERMIT MAY BE <br /> Phone: 259-BA7 5 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TH�S <br /> PROJECT OVER 90 DAYS OURATION. <br />