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Date"Gf�� '� � r_ <br /> PopLc Wnrks Per C' <br /> Applicedon For Bioe Deo��• ��1 <br /> PUBLIC WORKS PERMIT Pueto�slFe�FeP : <br /> Lese ApD��Fea PeiE S <br /> Print or Type Only aa�e�«o�s s <br /> ��_J� C_ VG��,��Il! ,P/g Ie�.�P.wJ <br /> Owner Madinq Address �iry Zi Phone <br /> P <br /> J �t3 ��av� �i�� S - �d�f �� lJ� 5�/ <br /> Apphcant MaJmg Address Cily Lp Phone _ �/ �� <br /> � �30 « <br /> Descrihe Proposed Work <br /> W <br /> Projecl Address�if known) � <br /> Aflach four(4)copies oi plans for prouosed work- Draw to scale and note ihe following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and tlimensions of all existing and • indicate North <br /> � �oposeo etructures on the lot • Show any proposed grading changes <br /> • Existing eno proGosed utilities • Show meas�remenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be m;�de 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be performed in acrordance with this permit and current Ciry ol Everett Design and Consiruction <br /> cta•dards and Specifications. <br /> 3. Catl Locztion Underground Service 48 hrs. b=fore you diy.TOLL FREE NUMBER 1•800•424•555$. � <br /> � � O <br /> C���' :��.,.�` ��a6 -�..�� <br /> `���' .�.w�, y�a�� ��� . I-- ' <br /> � <br /> �� �..�iy� �'��4,Lii2ey O <br /> 7 --��; // y a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City o! Everett irom any and all claims for Aamages. cosis, <br /> . expenses. or causes ol aclion ihat may arise Uecause ot installation <br /> and maintenance ol the improvement or other righFol�way use hereto <br /> apolied br and lurther agrees lo removr. same upon notice Irom Ihe <br /> Approved for Consiruction Dale City and to�eUlace pubiic property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Construcled Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPART1dENT WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Sireet 187 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 dE DILIGENTLY PUPSUED TO COMPLETION.TNIS PERMIT MAY BE <br /> Phone:259�8815 '%ANCEI.LED F1Y THE CITY L'PON ANY STOPPAGE OF WORK ON THIS <br /> F ROJECT OVER 90 DAYS DURATION. <br />