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. ._ .,�.;. <br /> Date/��(��/O6 PuOrvcWorbPermil• V � _��� <br /> � <br /> Applitation For emu ow�.• — <br /> PUBLIC WORKS PERMIT P��I�cWork�Fee <br /> Totel Fee s <br /> Less R001.Fea PeiE s <br /> Print or Type Only ���•�=�o�� f 2� <br /> �o�e.�u � �C/ 30- /4or.r ,t�'�, N��ys�n� Q8 2�a <br /> Owner MaiVing Address Ciry Zip Phone <br /> (o5z - 0�03 <br /> ApD��cant Mailing Address City Zip Phone <br /> DeacriDe Proposed Work ��J�(� 75�� ��SZLJ 7^� .C�/pC�-t'1 " <br /> �/o W <br /> Prolect Address(if known) T JG�— JE9v/EC�J _� � <br /> Atlach ic+ur(�)copies of piens for proposed work- Draw to ccale and note the followin�7 as applicable: � <br /> • Property Lines • Centerline�oi stree� � <br /> • Outline anC dimensions ol all ezisting and • Indicate North <br /> proposetl structures on Ihe lot • Show any nroposed grading changes <br /> • Existir�g and proposed utilities • Show measurements � <br /> DO NOT WHITE BELOW THIS LINE <br /> PERMIT COND�TIONS O <br /> 1. All calls for inspection shall be made 24 hrs. in advance-Ghone 25J•88�5. � <br /> 2. All work shell be perlormed in accordance with this permit and current City ol Everett Design and Consiruction <br /> Standards and Specifications. <br /> � 3. Call i.ocation Underground Service 48 hrs.before you dig.TOLL FREE NlIMBER 1-800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT CF CONDITIONS <br /> O,C %C.c' /��� �✓" C-•c>«� �.n� The undersigned owner/applicant hereby agrees lo hold antl save harm• <br /> � less Ihe City ol Everett irom any and all claims lor damages. costs. <br /> ezpenses, or causes ot action Ihat may arise because ol installation <br /> , �� �r v and maintenance f Ihe improvement or other right�ol-Nay use hereto <br /> -��� '� "��'�� U �' app6ed for nd urther agree� to remove same upon notice from the <br /> Approved lor Constr ion Date C� y and r ace publir,property damagetl thereby. <br /> ���� �- <br /> �'67 <br /> FI AIINSPECTION Date y- <br /> Approved as Consirucletl n of pp� a ate <br /> evemtt PUFiLIC WORKS DEPARTMENT WORF AUTH I D BV THIS PEHMii MUST BE SIARTED WITHIN <br /> � 3200CedarStreet 100 DAYS O TE PERMIT IS ISSUED AND THEREAF'TER IS TO <br /> Everetl,WA 98?01 BE DILIGEN PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259�8815 CANCELLED BY TIiE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PHOJECT OVER 90 DAYS GURATION. <br />