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<br /> Applicalion Fo� �
<br /> PUBLIC WORKS P�RMIT, PublrtWai65Fee —
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<br /> Ownei Madmg Address �3 � � � GtY r Zip Phone
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<br /> Applicant Mailing AAdress City Zip Phone
<br /> Describe ProPosed Work ������ ✓G ��n�✓f���”//1/4 ��•�/ � �=� � / �� � d �'^
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<br /> Proled Atldress Ut knaw�) / 7 i� / � ' 'r ' . � F. �'"'� �
<br /> Attach four 14)copies of plans lor proposrd work� U�aw to scale ana note the following as applicahle: �
<br /> • Praperty Lines • Centedine ol slreet , . _ y � �
<br /> • Ou�line and dimensions of all exlsting and • Indicate Norih
<br /> prc >used shuctures on the lot • Show any proposed grading changes
<br /> • Ex�s�ing and proposed wilities • Show measurements M
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<br /> DO NOT WRITE BEIOW TH�S LINE O
<br /> PERMIT CONDITIONS
<br /> 1.All calls for inspection shall be made 24 his.in advanca•phone 259�8810. �
<br /> 2.Ail work shall be peAormed in accordance wdh this permit wnd wrrent City oi Everetl Design and Consiruction �
<br /> Standards and SRecifications.
<br /> 3.Call Locetion Untlerground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800�424•5555. �
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<br /> ACKNOWLEDGEMENT OF CONDITIONS
<br /> The underslgned owner/apUlicant hereby ag�ces to hold^nd save harm-
<br /> — — - less the Cdy ol Everett Irem any and all Uaims lor demages. costs.
<br /> � ' ezpenses. or causes of ac�ion that may arise because ol installation
<br /> � � % •�� , j' and mointen2nce ol the improvemenl or oth�r ri9htrof�waq u �• hereto
<br /> .<'.,' .� � � � � • applled tor enA lunhei agrees to remove same upon nohce irom the
<br /> proved 1 Conslrur,tiun ����' Cily and�c re/ice pub�ic pr9���rly damaged IhereUy.
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<br /> PINAI I�SPECI"ION Oale � , Cate
<br /> Appruvetl as Conslructed Signatme afApplicanl
<br /> VJORK AUTHURIZED BY THIS PERMIT YUST BE STAFTED WITHIN
<br /> everet� PUBLIC WORKS DEPAPTMENT � 180 DAYS OF DATE PERMIT IS ISSUEU AN[) THENEAFTEF IS TO
<br /> � 3200 Cetlar Street BE DILIGLNTLY PURSUED TO COMPLETION. THIS PERMIT MAY OE
<br /> EvereD,WA 9820� CANCCLLE�BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS
<br /> Phon^.�.?59�88�0 pROJ[CT OVER 90 DA1'S DURATION.
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