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�7 ��� � w. <br /> Date-L./�.,— � • �-- ������,<<v�,w,a�,� �. _ _ <br /> glnp DeP� • �� - <br /> Applicalion For <br /> ___._—.___—_..__._ <br /> PUBLIC WORKS PERMIT °��°��°�°°°_`�� <br /> ,o�,���� g__— <br /> �ess nnni ian aa�o 5 — <br /> oaianceDue S <br /> Print or Type Only <br /> �-,-.���„ i,..�; �;`�. � � l -(��p,�,��'� �o�.��F� �?�2o I �5�-lp� �, <br /> Owner Mailing Address J Ci1y 7_ip Phone <br /> s nr� ► ��-I ���'' A�� S. ���a�c���c.�o �7l- <br /> Apphcant Naihn9 Address Gty Zip Phone i r?�� <br /> �-�e.ir-� <br /> Describe Proposed Work �-��/ ,�� <br /> - W <br /> , � � � <br /> Pro�ect Addiess Iif knownl <br /> Attach lour 14)cop�es o�P�ans tor proposed work� Draw to scal and note ihe tollowmg as applicable�. � <br /> • Property Lines • Cenlerline ol sireet � <br /> • Outlinc and dimensions ot all existing antl • Indicate North <br /> proposed sirucWres on Ihe lot • Show any proposed grading changes <br /> • ExiSUng and p�oposed ufildies • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PEFMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit and current City ol Everett Design and ConsVuclion <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �� �� ��� // � <br /> i.i �1,�r.'!7G�Ti`" �" � <br /> �7 <br /> �— ?G -:Y� � <br /> � <br /> a <br /> ACKNOVJLEDG[MENT OF CONDITIONS <br /> Tha undeisic�ned owneV.�pp�icant hereUy agrees to hold and save M1arm� <br /> le.,s the C0y ol Everett Irom any and ail claims lor Aamages, costs. <br /> e*penses, or causes ol action that may arise because ol installation <br /> and maintenance ot Ihe improvement or other nght-ol�way use here�o <br /> applmd lor and lurther ayrees to remove same upon notice Irom ihe <br /> Approved lor Consiruction Dale City and to rep�ace pu�lic property damaged thereby. <br /> FINAL INSPECTION Date Date <br /> ApproveG as Constructed Signatwe ol APPhcant <br /> WORK AUiHOR12ED BY THIS PERMIT MUST B[ STARTED WITHIN <br /> ��� PUBLICWORKSDEPARTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street pE DILIG[NTLY PURSUED TO COMPLETION. TNIS PERMIT MAY BE <br /> Everetl,WA 9H2O1 CARICELIED BY THE CITV UPON ANY STOPPAG[OF WORK ON 7HIS <br /> �J Phone:259�8870 PROJECT OVER 90 DAYS DURATION. <br />