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Date � �" � P��,�,.�vo��.v��m,. c� 32- <br /> Application For � �i�9 Deni-� <br /> .: ^ <br /> J <br /> PUBLIC WORKS PERMIT Q������ Pu�llcWo�MSFee $ � s�� <br /> Tn�al Fee <br /> � LCSSAppI FPPPdIa 5 <br /> Print or Type Unly �. Bnlance0uc s <br /> �t I �-r��� 1��� 1�� I��,�IL� � /�L/� `�C a�r;=� �5�-9�3/� <br /> Ovmer Mailing Address Cdy Z�p Phone <br /> P, <br /> Applicant Mailino Address City 2ip Phone <br /> Describe Proposed Work �� � �����!�-u-.�--�-�� l� <br /> W <br /> Project Address(il known) <br /> io � ' �' � I— <br /> A�tach low(4) copies ol plans lor proposed work- Draw to scale and no�e the lollowing as applicable: � I <br /> • Property Lines • Centedine of street � I <br /> • Outline and dimensions ol all exisling and • Indicate North <br /> proposed siruclures on�he lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS I.INE O <br /> PERMIT CONDITIONS <br /> 1. All calls lor inspection shall be made 24 hrs. in advance-phone 259•881 5. � � <br /> 2. All work shall be performed in accmdance wi�h ihis permit and current City of Everett Design and Consiruction I <br /> Standards and Specifications. I <br /> 3. Call Location Underground 3ervice 48 hrs.be�ore you dig.TOLL FREE NUMBER 1•S00•424-5555. � <br /> �, J� r ca .-�.-,�� ��.,..a � <br /> �� � O � <br /> H <br /> � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownedapplicant hereby agrees lo hold and save harm- <br /> less lhe Ci�y ol Everett irom any and all claims lo� damages, cosis, <br /> expenses, or causes of aclion that may arise because of installation <br /> ? � ,r� and maintenance ot the improvemenl or other right-of-way use hereto <br /> il ����—����`� � v� applied for anff furiher agrees �o re ve same upon notice Irom the <br /> A proY tl I i Cons�uction �- Date ���y and !o rej�la public properly maged Ihereby. <br /> � <br /> i -� <br /> l�l fQ�,� ,�- �Z�b <� �� � '� �-�-- ` z3 �' <br /> FINAL INSPECTION Dale / � ' <br /> Approved as Construded Signature ot Applicant ate <br /> everMl PUBUC WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN � <br /> 180 DAVS OF DATG PERM1IIT IS ISSUED AND THEREAFTEP IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everetl,WA 98201 CANC[LLEO BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 PROJECT OVER 90 DAYS DURATION. <br />