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Date� �T��—S{ <br /> PueecwoiwsPmmn `� �� <br /> Application For B��a o`P�.•--`I—"— <br /> PUBLIC WORKS PERMIT P°°To;aF�e°,° $ <br /> less noo� Fec PeiJ S�. <br /> Balanco Our $ �Q� <br /> Print or Type Only <br /> )�rn�'� �� -�1a271' (� � �v� �Fs��1 ��y���, � <br /> Owner Mailing Addres� Gry Zip Phone �� <br /> c W 1 1 {� <br /> Applicant Mailing Address Cily Zip Phone <br /> Describe Proposed Work �L��� � -� Iv I <br /> _ 9��s - �`. �� s=� W <br /> Prcject Address lif known) � <br /> Attach lour(4�copies of plans tor proposed work- Draw to scale and note Ihe tollowing as applicable: � <br /> • Property Lines • Centedine ot stree: � <br /> • Outline and dimensions ol all existing and • Indir.ate North <br /> proposed st�uctures on ihe lot • Show any p�oposed grading changes <br /> • Exicting and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall Ge made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be peAormed in accordance with Ihis permil and current City of Everelt Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Undergrou�d Service 48 hrs,before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> O <br /> � � <br /> N <br /> O <br /> a '� <br /> � <br /> ' <br /> ACKNOWLEDGEMENT OF COND'TIONS ', <br /> The undersignec o�oner/applicant hereby aaiees:o hold and save hann- ' <br /> — luss the City ol Everett Irom any and all claims for damac�es, costs, <br /> expenses, or causes ol aclion ihat may arise because ol installation <br /> ��� j� � and maintenance ol the impr vement or �Iher right-ol�way use hcreto <br /> � applied lor and further agre 5 lo remov? same upon nct�r.e Irorr the <br /> �;ppro�ve Or Consiruction Da Ciry and t place pu lic p per�y damaged thereby. <br /> / ' �� `��J� �� c� 7 . <br /> .i/ �� C <br /> FINAL INSPECTION � �e�e °� _ �o � �� <br /> Approved as Constructed Signat e of Ap c p Date <br /> everelt PUBLICWORNSDEPARTMEVT W AUTFIORIZLD BY THIS PERMIT MUS'( BE STARTED WITHIN <br /> � 3200CedarStreel 1 DAVS OF DATE PERMIT IS ISSUEU ANt) THEREAFTER IS TO <br /> BE DILIGL=NTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLGD BY THE CITY UPON ANY STOP'AGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />