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. <br /> Date��q � '�� <br /> � Puel¢wo.hs Parmlt• <br /> Applicetion For oiaa oeo�.+ - � d� <br /> PUBLIC WORKS PERMIT PU�TotplFeeFee s <br /> Leas Ropt Fee ParO S <br /> Print or Type Only Baiance0ue S <br /> .�i��r�c� ro%de// aS35 /N,v.��n� S'f �ii�i��1� S��'�r.3 355-�3�' <br /> Owner Maiting qddress Gly Z�p Phone <br /> �!a!11D�✓ <br /> Applicant Mailing Address �ity Zip Phone <br /> Describe Proposed Work � �1'r/��/ G�N r"e /)� /y rYN?� �(Q� _ <br /> . Project Address(if known) /'Z f� � <br /> '�. Attach four(4)copies of plans tor proposed work• Draw to scale and note the foltowing as applicable: � <br /> . • Property Lines • Centedine of sireet � <br /> . • Outline and dimensions ol all existing and • Indicate Norih . <br /> proposed structurer,on the lot • Show any proposed grading changes <br /> � • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> '� PERMIT CONDITIONS � <br /> 1.AII ca�ls for inspection shall be mede 24 hrs.in advanc� phone 259•8810. � <br /> 2.All work shall be pertormed in accordance with ihis permil and current City oi Everelt Design and Consiruction <br /> Standards end Specifications. <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> �Lc,�' ���-' /��,>��.rf/L��,C4'�. 0 <br /> .�`���Y.�� � <br /> ���G ' J�� � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby ag�ees to hold and save harm� <br /> less �he City of Everett trom any and all claims for damages, costs. <br /> expenses. or causes of action Ihat may arise because ol installation <br /> and maintenance ol the improvement or other righbot-way use hereto <br /> applied lor and lurihe� agrees �o reoiove same upon noticr. �rom �he <br /> Approved for Construction Date Ciry and to replace public pronerty Aamaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Consiructed Signature ol Applicant Date <br /> evere[t PUBL!G WORKS D[PARTMENT �'ti'ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 8't DILIGENTLY PURSUED TO COMPL[TION. THIS PERM�T MAV 8[ <br /> Phone:259-8810 C4NCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THI3 <br /> P170JGCT OVER 90 DAYS DURATION. <br />