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u <br /> i: �Q � <br /> 3 /7 � =� `� y� <br /> C/l1E P„nec wo,�:veimn. ��.�— <br /> Bm0 Dept• <br /> ApP�ication For ,.i <br /> PUBLIC WORKS�ERMIT �°°°°W°��s��° -- <br /> 1o�al Fec S <br /> Oless Anpi Fa,e Pnia S — <br /> O Z�� <br /> � p p Bauncr Due � _ <br /> Print or Type Only o 0 <br /> O N N <br /> ( lv�-,Jf�,+-� ,�f� v/�A l��S" i2��1��-l(�ii- L-�.�el�ctf > �tl� �!2'2vr zsX - �/s-(, s <br /> p,�,�e� MaJing Add�s� � � y City Zip Phurc <br /> � � � � <br /> S�✓"�.F Md' YC o U <br /> Applicant Mailing Address City Lp Phone <br /> Descrihe Proposed Work ln S la-'��`� �/�l� [ � -r ��"�"/�C / 'E'�^-U • �Y cM�'� 7 -f_a-.U <br /> � !n/-U D � 7 i� f �� Yt� _ - ,`h",T G J� S � � 9.,� <br /> r� a-��_ N ;� l z ' . < � s,�e��,.m_ P �, ,' -1-;.� <br /> , <br /> c� -'` I .e '� � ���w,.-._ ; ,� 1 , <br /> Prolect Address(il known) ""- - << "�"� �'� � � <br /> Attach four(4)copies oi plans lor proposed work� Draw to scale and note the followiny as applicable: � <br /> • Property Lines • Centedine of street � <br /> • Outline and dimensions of all exisling and • Indicate North <br /> proposed struclures on the lot • Show any proposed grading changes <br /> • Ezisting and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls lor inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.Atl work shall be peAormed in accordance with this permit and current City of Ever.tt Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> c <br /> The undersigned owner/applican�hereby agrees to hold and save arm• <br /> less the Ciry ol Everett irom any and all claims for damages, costs, <br /> expenses, or causes of ac!ion that may arise because ol installation <br /> ��[/ /J / and maiNenance of ihe improvement or other righPo4way use hereto <br /> �fi70z,/�. J� —�C-�9 appl�eA !or and lurther agrees to remove same upon notice trom the <br /> Approved lor Cons ruction� �a�e City �d to replace public properiy damaged thereby. <br /> i��L_ ' // .f� �� <br /> FINALINSFECTION Date .1���� �y�� '" " %y <br /> Approved as Construc�ed Si�naWre ol Ap�licaN Dale <br /> WORK AUTHOfiIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMF.NT 1 g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200Cedar5lreet BE DILIGENTLY PURSUED TO COh1PLETION.THIS PERMIT MAY BE <br /> Everett,WA9820t CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJEC7 OV[R 90 DAVS DURATION. <br />