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Date�� �„��,�w�,k,P�,�,,. 8'g' S�S�_S <br /> Application For o�ao o�n� • . _ __ <br /> PUBLIC WORKS PERMIT CU�Toiefen��� : — <br /> Lena Aon� Fee Pa�O S <br /> Print or Type O�ly Ba�r„=Bo�� s 2� <br /> ��.1� c i I r5 1a33 olun�Q��G T1L �`Dt�'t�,S <br /> Owner Mailing Address ny Zip Phone <br /> (o�a-I-�__ <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work � 1f�.u7 � - <br /> Pro�ect Address lil known) �� ��— "���0� �, � <br /> � <br /> Atl�c�lour�4)copies ol plans lor proposed work� Draw to scale and note Ihe following as applicable: � <br /> • Proparty L�nes • Cen�e�line of Sireel � <br /> • Outline and dimensions ol all existing ana • Indicale North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Exieting and proposed utilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> i.All cslls for Inspection shell be mada 24 hrs.in advance-phone 259•8810. � <br /> 2.Aii work shell be peAormed in accordance with this permit and current Gity of Everett Design t,id Construction <br /> Standards end Speclficatlons. <br /> 3.Cell Locetlon Underground Service 48 h.rs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigneo owner/apVGcant hereby agrees to hold and save harm- <br /> — less ihe Clly ol Everett Irom arry and all claims loi damages, costs. <br /> //�/ , ./� �1 expenses, or causes ol action Ihat may arise because �f installa!�on <br /> ���a�u✓ �10D�n� ��///� and maintenance of the improvement or other ngh!-o1�waY �se heretn <br /> applied lor and lurther ayrces to remove same upon notice Irom ihe <br /> Approv�.�or Cons ruction Date City and to replace public property damaged thereby <br /> __��/ �n � ��/? C . 7 <br /> r � c l�"� —d't� <br /> FI AL INS E .ION Date <br /> Approved as Constructed Sign Wre of Appli Date <br /> everett PUBLIC WORKSDEPARTMENT WORK AUTHO ED BY ThiIS FERMIT MUST BE STARTED WITHIN <br /> 180 DAVS OF DATE P[RMIT lu ISSUED AND THEREAFTER IS TO <br /> � 3:OOCedarSireet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY f3E <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone�.259�8810 pROJECT OVER 90 DAVS DURATION. <br />