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pg�g 1� 0� aum�¢Worka Permn• �'S�p3 <br /> Application For e�ec�oeo�.• Y-s��y�Y� <br /> PUBLIC WORKS PERIVIIT PubTaalFeeFae s <br /> ILesa AD�I.Fea Pa1E S ��_ <br /> Balance Dm S <br /> Print or Type Onry g�739 <br /> L��,tJ�'� �ccr5 /lomes �f, S�'Ev�n1Ru. ti/Ay l�/�,� 9�Zay t3Ss-y4�iz <br /> Owner Mailing Address City Zip Phone <br /> ��UNG�- <br /> Applicent Mailing Adtlress City 2ip Phone <br /> Describe Proposed Work ��ST'�'tL as� W�vE (ONCRET� t7le/GtZU/4"`/ <br /> W <br /> Project Address(il known) ���'— �E « � - S � _ � <br /> Attach lour(4' copies of plans lor p•oposed work- Draw!o scale and note the lollowing as appGcable: � <br /> • 1-.operty Lines • Centerline of street � <br /> • Jutline and dimensions ol all existing and • Indicate North <br /> proposed structures on tha lot • Show any proposed grading changes <br /> • Existing ard proposed utili�ies • Show measuremenis � <br /> DO NOT W91TE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls tor inspection shall be m�de 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shall be performed in accordance with Ihis permit and wrrent City ol Everett Oesign and Construction <br /> Standards and Specificaiions. <br /> 3. Call Location Underg�ound Service�8 hrs.betore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> 7. �j�GOiivc� l�F LOT To 6E Ol'..t/E SO AS ���'T To � <br /> 7ir�F'Ac;T TiYE At�i AC�n1T P,t."�:r?s��icS <vi�/! <br /> iC"q,•it/•.vYd T!� iG't-if/ l�Ff. � <br /> � .�'�Oc:c..���:cS' A,E'F .Ul�a9 liti�d,�'e',rr� A�vr /�dmdc�t' �/� <br /> To TirEm s�facL '� •PE-f'N>.eE�D ay i�lE� Ai>.���con,�T. V� <br /> O <br /> a <br /> ACKNCWLEDGEMENT OF CONDITIONS <br /> The undersigner owner/applicant hereby agrees to hold and save harm� <br /> less the Ciry oi =���rett irom any and all claims for damages, cosis, <br /> —/ expenses. or cause� of action Ihat may arise because of installation <br /> L' �{�/� /i cJ�S�S. and mainlenance of the improvemene or other righPof�way i�se hereto <br /> �IL � �"��' � applied for and luriher yrees to remove same upon notice Irom ihc <br /> ApP�oved for Consifuc '� i pa�e y d�o replace pub c property damaged ihereby. <br /> � � <6 3 l � �-.1�,,� � � -.�o—�J� <br /> FINAL INSPECTION Dale � <br /> Approvzd as Constructed S' nature of Applicart Date <br /> evc;etl PUBLIC WOaKS f7EPARTMENT . OFK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everelt,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAG[OF WORK ON THIS <br /> Phone: 259�8815 PROJECT OVER 90 DAYS DURATION. <br /> iJ <br /> 9 <br />