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r� , <br /> Date=' " � PuUlic WorMa Perm�1� <br /> Applicalion For eiep.o�o�.• <br /> PUBLIC WORKS PERMIT � � PuClicWorkaFee s <br /> �/ �,y/ Tottl Fsa <br /> A � L� � \ Leaa Aoo�Fae PaiO S <br /> {� , �1� :� Baiance oue S <br /> Print or Type Only �Q� � 1L1 'L <br /> � r <br /> ,.� , � .. . �'���i� S�irzjl.�� C <br /> wner Mai{ing Address Cily Zip Phon� � <br /> �aUb� e ('lur� �'�� 1?�a�Krr- �c�u�i— ���z��( �s�-�,�,s <br /> � Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work �.��� `���"�`�� 7��� � � �Z'�� ��C`� � � <br /> W <br /> ProiaW Address(il known) � �ti�� �1�-�� � <br /> Attach four(4)copies ol p�ans lor proposed work• Draw to scale antl note ihe lollowing as applicable: � <br /> • Property Lines • Centerline of street ♦A <br /> • Outline and dimensions of all existing and • Indicate Norih V� <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposBd uti�ities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THiS LINE O <br /> PERMIT CONDITIONS <br /> 1.All celis for inspection shall be made 24 hrs.in advence•phone 259-881 O. � <br /> 2.All work shall be performed in accordance with lhis permit and current City of Everett Design and Constructiun <br /> Stenderds and Specifications. <br /> 3.Call Locaflon Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �Q ' --r�.S _ O <br /> NO 9�21 ��veWn; S �•�' r <br /> block �., w�E s,de oC'��nal— er�n,��" � <br /> �,•� 1NITIAL INSPECTION �`'�11z � v+ <br /> �,{.,;.. ,. I,�IRK-BROOK$ S- 3 � -� `f- O <br /> y� �.. ; : _ a <br /> 7 n / _ .: � <br /> BATS __ <br /> �i ct�so �a.�.e c��ave.� <br /> G�-� �t R.T� �pikw -y�.c� qCKNOWLEDGEMENT OF CONDITIONS <br /> � � 4.{ U����, p � The undersigned owner/applicant hereby agrees to hold and save harm� <br /> 0.�I� . less Iha Ciry ol Everell Irom any and all claims tor damages, cosls, <br /> expenses, or causes of action thal may arise because of installation <br /> and maintenance ol Ihe improvement or other right•ol�way use hereto <br /> applied lor and lurther agrees to remove same upon notice Irom Ihe <br /> Approved lor Construction �^�e City and lo replace public property dama9ed Ihereby. <br /> FINAL INSPECTION Date Date <br /> Approved as Conslructed Signature ol Applicant <br /> WORK AU?HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> PUBLIC WORKS DE?ARTMENT 180 DAYS OF DATE PERMIT IS IS."iUED AND THEREAFTER IS TO <br /> ��r� 3200 Cedar Street BE DII.IGENTIY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> ��hc7T Evered,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />