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Date _,� <br /> PuoLc Wo�hs Permil• <br /> Applica�ion FOr eieq Deo�.e.91��(p �i� <br /> PUBUC WORKS PERMIT Pu�LCWmheFee <br /> TO�TI FpB S <br /> Less Appl.Fee Paid S <br /> Print or Type Only ea�r��eo�e s <br /> — SNorYDM/SN f��y�r�/.�',� <br /> ' Owner Mailing Address <br /> ���Y Z'p Phone <br /> _G'ARY P.4�P[�/�t.Ct'n� � ,an�,� � s��� re�By � F��.,P�T.�9f�2�i �s2 �53 <br /> App6cant Maihng Atldress Cit <br /> Y Zip Phone <br /> Describe Proposed Work �•1 � <br /> Project Address�il known) if5'�R � ) �/� � <br /> Attach four(4)copies oF p�ans lor proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ol street <br /> • Oulline and dimensions of all existing and • Indicate North � <br /> proposetl structures on Ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis <br /> DO N07 WRITE BELOW THIS LINE � <br /> PERMITCONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•$$10. <br /> 2.All work shall be peAormed in accordance with rhis permit and current City ot Everett Design and Construction � <br /> Standards and Specificationa � <br /> 3.Call Location Underground Service 48 hrs.befor=you dig.TOLL FREE NUMBER 1•$00-424•5555. <br /> � <br /> �.�ldr��e�.f�P/�-r�,cQ�,�,,,� O <br /> yJi'.�E��- <br /> '-f`9/ �, <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> TGe ur.dersigned owner/applicant hereby agrees lo hold antl save harm� <br /> les: Ihe Ci�y of Everett Irom any and all claims for damages. cosis. <br /> ezpcnses. or causes ol action that may arise because ol inslallation <br /> and mainte�ance of ihe improvement o�other right�o4way use hereto <br /> Approved for ConsVuction pa�e applietl lor and �urther agrees to remove same upon notice Irom the <br /> Ciry and to replace public property damageC ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAFTED WITHIN <br /> � 3200CedarStreet 180 PAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> Everett,WA g8201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�BB70 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />