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e7-ii9 <br /> Date ,(� PWiic Wo�hs Permit• �� <br /> y-1�1-�. <br /> eiae�o�o�-+ <br /> AppllcYion For ` <br /> PUBLIC WORKS PERMIT P°°"`W°`""°' s_ <br /> Tot�l Fee <br /> Lese ApP��Fea PaiE S�--- <br /> Balance0ue s ��� <br /> Print or Type Only <br /> m�i-��i5 As�G^ ��� �',��aLG.c�_� ����C�ZC-' as�-►Ir� <br /> Owner Mailing Address Cdy Zip Phone <br /> '�\��, r'i�n I\1 1/'V ^ ,r-�.3�� <br /> �-�AI cant Mailmg Address C�ly ZiP Phone <br /> PP <br /> DescribeProposedWorN �f� l� c'FI <br /> — — - � <br /> Project Address(it knewn) �l�� � SK(�� /NE �.f' � <br /> Apach four(4)copies rd plans for proposed v:o�k• Draw to scale and nole the following as apGlicable: � <br /> • Property Lines . • Centedine ot street � <br /> • Outline and dimensions of all ezist!ng end • Indicate Nor�h <br /> proposed structuras on the lot • Sh�w any proposed grading changes <br /> � Existing and proposed utilities • Show measurements . M <br /> W <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMITCONDITIONS O � <br /> 1. All calls for inspection shall be made 24 hrs.in advance• phone 259-8815. � '. <br /> 2. All work shall be pertormed in accordance with this permit and wrrent City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Localion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•80rJ•424-5555. � '. <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLFDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby egrees lo hold and save harm- <br /> less ihe City of Everett fran any and all claims for damege& costs, <br /> expenses, or causes of action that may arise becauae of instelleNon <br /> � ` � �* and mainlenance of the improvement or other right•ol-way uee h�reto <br /> �(y)O�f�.� �2 lied tor and lurther agrees to remove sama upon notice Irom the <br /> Approved for Constr ' n �1e Cit nd to replace pub'e'{�iopertf�d,amaged !her�by. <br /> 'J�—��, —� ^ � J <br /> FINALINSPECTION Date CL� �'��'� �t ��� ' � <br /> Approved es Constructed ' ture of A�pl �ate <br /> WORK AU ORIZED BY THIS PERM�T MUST BE STARTEC WITHIN <br /> evere[t PUBLIC WORKS DEPAR7MENT 7g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAF7ER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCEL�EL BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�88'pd pROJECT OVER 90 DAYS DURATION <br />