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Date �'�' z�-,� 7 ��,����,�w�,.���,m��• 7 /�F �3 <br /> Application For aiec ooni •� � <br /> PUBLIC WORKS PERMIT r°°To,aFaa`°° : <br /> Lesa AO��Fee Pa�U S <br /> Balnnce Due s <br /> Print or Type Only <br /> �u„i;,' -T � --- � ,�� � � �,'orka�� l���� ��Pretf- bU/-� <br /> Owner Mailing Address City Zip Phone <br /> .Sa M Q -- <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work ��, n✓� � r f � �j l!i/ l�Nv <br /> f1 W <br /> Proiect Address(il known) a�.� � 7C nr�c P Tn �� F r ~ <br /> Attach four(4)copios of p�ans lor proposed work• Draw to scale and note the fotlowing as applicable� � <br /> • Property Lines • Centerline ol sireet � <br /> • Outline and dimensions of all existing and � Indicate North <br /> proposed structures on the lot � Show any proposed grading changes <br /> • Ezisting and proposed u;ilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be performed in acwrdance with this permit and current City ot Everetl Design and Constructlon <br /> Standerds and Specilications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> T �S 87 O <br /> �U�33Z/C Lc�.e.�' �ir��i .r/OT ,('Fqcv,eE'o ���� <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF(:ONDITIONS <br /> The undersigned owneUapplicant hereby ag�ees lo tiuld and save harm• <br /> less the City of Evereti from any and all claims lor damages, costs, <br /> ezpenses, or causes of action that may arise because of in;taltaHon <br /> and maintenance of Ihe improvement or other right•of-way use hereto <br /> applied lor and �uriher egrees to remove same upon notice from the <br /> Approved fo�Construction Date City and lo replace public property damaged thereby. <br /> FINAL INSPECTION Date Date <br /> Approved as Consiructed Signature of Apnlicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT �g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Streel BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,W�98201 CANCELLED BY THE C�TY UPON HNY STOPPAGE OF WORK ON THIS <br /> Phone: 'L59�B815 PROJL=CT OVER 90 DAVS DURATION. <br />