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Date �oc- �D P��i��wo,w.Pe,mn. _ <br /> Application For am9 oen� • — <br /> PUBLIC WORKS PERMIT PuUTolalFceFeo S - <br /> Less noo��ce Pa�a S <br /> 6aiance Due a <br /> Print or Type Only <br /> �►rn�l �he�l I <br /> wner Mading Address C�ry up Phone <br /> Applicant Mailing Address Clly Zip Phone <br /> Describe Proposetl Work _��4 � <br /> W <br /> Prolec�Address li�known) �s�� "��� � � <br /> Attach lour(4)copies o1 plans lor proposed work- Draw to scale and note the lollowmg as aUP��cable: � <br /> • Property Lines • Centerline ol sireet /A <br /> • Outline aod dimensions ol all exis�ing and • Intlicale North V� <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utililies • Show mea_.urements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls tor inspection shall be made 24 hrs.in advance•phone 259•8810. ^ <br /> 2.All work shall be pedormed in accordance����th this permit and currenl Ciry of Everett Design and Construction ♦ <br /> Standerds and Specilications. <br /> 3.Call Localion Undergmund Service 48 hrs.6ebre you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> — � !/ ci%' � C ��C�CP/f��2;e'G�G�/QG� U!/te'�-�t/ ��� O <br /> 4 � � <br /> ��� �������-�" ���� .`� V� <br /> L'C�_2��'8 O <br /> a <br /> ACHNOWLEDGEMENi OF CONDRIONS <br /> The unders�aned owner/applicant hereby agrees lo hold and save harm� <br /> � Iess the Cdy of Gveretl lrom any and all claims tor damages, costs. <br /> expenses, or causes of zclion thac may arise because ol installation <br /> and maln�enance of the unprovemeM or olher righ4of�way use he�elo <br /> applied ior and �urther ayrees to removc same upon notice ��om the <br /> Approved lor Consiruc�ion Date City and to iepiace pubhc properry damaged ihmeby <br /> FINAL INSPECTION Date <br /> Approved a5 ConsVucted Signature of ApPlican� Date <br /> WORK AUTIIORIZED BY TIiIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSD[PARTMENT 1B0 DAYS OF DAT[ PERMIT IS ISSUED AND THERE�FTER IS TO <br /> � 3200 Cedar Street BE DILIG[NTIY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br /> Everett,WA 98201 CANCELL[D BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phon¢259-8810 PROJLCT OV[R 90 DAYS DURATION. <br />