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Date � y � <br />PUBLIC <br />Print or Type Only <br />� <br />Application For <br />WORI� <br />O <br />� <br />� <br />� <br />PERMIT <br />� � <br />00 <br />a� <br />Owner� rnaixng$oa�qpiy_ z(� <br />M O 3 ¢ <br />Sp►+� � � � U <br />Applicant Mailing Address <br />Descnbe Proposed Work <br />Project AAd�es5lii known) <br />v��ni,� wo,�e ra�mn . Ln <br />� -�s�� <br />eina oeci. • —��o.ys <br />.. I vunucWorwe�ee a -- <br />loiM iee <br />Le55Rp01 FeePeid S <br />a �� �O <br />Baianr.r poe <br />Phone <br />2ip Phone <br />Attach four (4) copies of plans for proposr.d work • Draw to scale and nofe ihe following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing anA • Indicate North <br />proposed structures on fhe lot • Show any proposed arading changes <br />• Ezisting and proposed utilities • Show measuremenis <br />PERMIt CONDITIONS <br />1. All cells lor inspection shall be mede 24 hrs. in advance - phc�e 2F9•6810. <br />2. All work shall be pertortned in accordance with this permit antl current City of Everett Design and ConatrucHon <br />Standerds end Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•SSSS. <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 99201 <br />Phone:259�BBt0 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City ol Everetl irom any and all claims for damages, costs, <br />ezpenses, or causes ol action that may arise because of installation <br />and maintenance of the improvement or othe� right�ot•way use hereto <br />applied lor and further agrees to remove same upon notice irom ihe <br />C�ty and to replace public property damaged Ihereby. <br />'��"-� � _ <br />Signa re ol Appl� a Dat <br />WO� AU7HOF71 BY THIS PEFMIT MUST BE STARTED WITHIN <br />180 DAYS OF DAT[ PERMIT IS �SSUED AND THEHEAFTER i5 TO <br />BE DILIGENTLY PURSUED TO COMPLETION. 1415 PERMIT MAV BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE. OF WORK ON THIS <br />PROJECT OVEfI S^ DAYS DURATION. <br />