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i <br /> D�te.�'�� P�b���•�a���P m��. _ g7".37�' <br /> Application For Bldg Depl.s � <br /> �UBLIC WORKS PER" ''T Publlc\YorkSFee <br /> totalFeo $— <br /> Less Appl.Fee Pe�a � <br /> Print or Type Only 8.,�'�"°°� $ 2��— <br /> ��'(.�1'.1� y}��I��� Y1fC'�n� 7�� �l-I�IIIF°.(�' � 4811� � —7�� <br /> Owner Mailing Adtlress Ci�y Zip Phone <br /> �`a31'l'lfi <br /> Applicant Mailing Address Ciry Zip Phone <br /> Describe Proposed Work �����i <br /> Project Address(if known) � G �-� ' � <br /> � <br /> Attach fuur(4)copies of plans for proposed work- Draw to scale and note the following as applicable; � <br /> • Property Lines b Centerline ol street � <br /> � Outline and dimensions of all existing and • Indicate Norih <br /> proposed structures onthelot � Show any proposed grading changes <br /> • Existing and proposed utililies • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspection shall be inade 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shell 6e oerformed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location l:nderground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•S00•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undeisigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe Cily ol Everett Irom any and all claims for damages, wsts, <br /> expenses, or causes ol action that may arise because of instailation <br /> ���� O /��9 �7 and maintenance of ihe improvement or other right-oFway use hereto <br /> 4�-- ��� applied for and further agrees to remove same upon notice from ihe <br /> Approved br ConSGuction �� Ciry and to replace public properly damaged Ihereby. <br /> S — 8r C��C�c.,��., �cr� v //— .3D—�' % <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant ' Dete <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMI' MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 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 OV[R 90 DAYS DUFATION. <br />