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Date.��'1 P�o�,�wo��a�,m,�p.� <br /> Application For BIOg Deot�_ X �� <br /> PUBLIC WORKS PCRMIT v��ToleFeeFoe s <br /> less Appi.iee PaiE � —. <br /> Print or Type Only Ba�a�=�u�e s <br /> .�a C�'Y� i r� Cml�� <-l(v� ��lv��.�� ,� LG��� l-rt'iP1� �r�x`,� � aZS.� - �5�� <br /> Owner Mailing Adtlress � City Zip Phone <br /> �n H�1. <br /> Appiicant Mailing Address City Zip Phone <br /> Describe Proposed work 'f���()[�@ �4-I n'T /t����f W��Gl 5(�����,/„ /r:rT"` <br /> W <br /> Prolect Address(il known) S . � <br /> Altach four(4)copies of plans for proposed work• Oraw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of streat � <br /> • Outline and dimensions of all existing and • Indicate No�ih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Ezisting and proposed utilities • Show mc�asuremen�s � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs.in advance- phone 2S9•88�5. � <br /> 2. All work shall be performed in accordance with this permil and current Ci�y of Everett Design and Consiruction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•8f10•424•5555. � <br /> G � �7 O <br /> /L��J'f i� CIIO�.CS l L�•E'/»/% /l/c�.i� ��� '�=.U_ <br /> 'l" � <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and snve harm- <br /> less the Ciry ot Everett Irom any and all claiins for dameges, cosie. <br /> expenses, or causes of aclion ihat may arise because ot installalion <br /> and maintenance ot lhe improvement or other right-ohway use hereto <br /> applied for and luriher agrees to remove same upon notice from ihe <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Cons�ructed Signature of Applicant Dete <br /> �everett f UBLIC WORKS DEPARTMENT WORK AUTHOf712EG BY iHIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Sireet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everetl,WA 98201 BE DILIGENTLY PURSUED TO CC'MPLETION.THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> _, PR O JE CT OVER 90 DAYS OURATION. <br />