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Date.J�I�L_ZZ/«� ruenc wo�1�aerma• <br /> eiea oeo�.• <br /> ApptLation For <br /> PUBLIC WORKS PERMIT PubTolalFeFP• s <br /> LessAOD�F.+PeiC S— <br /> Balence�ue S <br /> Print or Type Only <br /> ,�� 1�q�A- ISII ���E'rluo,P� l4uF EV��' lF�zol 339- 5�v� <br /> fM1 U <br /> Owrv:r MailingAddress Ciry Zip Phone aEf-n.c.E /U%30 � <br /> ��I1a� <br /> � <br /> Applicant Mailing Address City 2iP Phone <br /> �'1, ,y1� � l',(,�t�--}-wto�� /�vE <br /> Describe Proposed Work � �"SL"`� ����U� � � - <br /> M H <br /> H '+] <br /> W N � <br /> Projecl Address(if known) � ( � .� <br /> Attach four(4)copies ot plens lor proposed work-Draw�o scale and ncle ihe following as applicable: � � <br /> • Property Lines • Centcrline of sireet � � <br /> • Outline and dimensions ol all existing and • Indicate North �..i <br /> proposed structures on ihe lot • Show any proposed grading changes � Z <br /> • Existing and proposed utilities • Show measuremenis M � <br /> W H <br /> DO NOT WRITE BELOW T11IS LINE O N <br /> PERMITGONDITIONS "� � <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � � <br /> 2. All work shall be performed in accordance with this permit and current City ol Everett Design and Construction H <br /> Slanderds and Specifications. N <br /> 3. Call Locatlon Underground Service 40 hrs.before you dig.TOLL FREE NUMBER 1•B00•424-5555. � � � <br /> -.� �����C����/�s O . <br /> ���'� � 2�f���� � <br /> i� SE'cTn^� F � <br /> Os�i S ZY ' �-5 N � <br /> �� ��C, /.�,/�- AGG��/� <br /> G/Te7,�E' /.1c'cFss of1� / O N <br /> ` a � <br /> MQ <br /> t'1 <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/appfcant hereby aarees to hold and save harm- <br /> less the City of Everetl Irom any and all claims for damages, custs, <br /> expenses, or causes of action Ihat may ari,e because of installation <br /> and maintenance of Ihe improvement or other rigM-obway use hereto <br /> applied lor and lurther agraes lo iemove same upon notice from the <br /> �pproved(or Construction �a1e Cily and lo replace public property dama9ed ihereby. <br /> FINAL INSPECTION Date Date <br /> Approved as Construcled Signalure ol Appliwnt <br /> WORK AUTHORI2ED E3� THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT �gp DAYS OF DATE PERMIT IS ISSUED AND THEREAF7ER IS 70 <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLE710N.THIS PERMIT MAY BE <br /> [verett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8015 PROJECT OVER 90 DAYS DURATION. <br />