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DAte�� a�oec works ver a� <br /> AapliCalion Pcr Biop.oeoi-• � <br /> PUBLIC WORKS PERMIT PueTotelFeeFee s <br /> Leea R�pl Fea Peid f <br /> Print nr Type Only e.m��e o�a S <br /> IM t u'� V 7���n,�-�tt.e`i.�*c�'� t--c.�.t `C <br /> ���n� MaiNng Address City Zip Phone <br /> � c9�c�_ ��.-�_ ��io —������ <br /> Applicant Mailing Atldress City Zip Phone <br /> Describe Proposed Work � - «eo{QGs-�/ <br /> Prolect Pddress(if known) � � � � � <br /> Attech lour(4�copies of plan^,for proposed work• Draw to scale and note ihe lollowing as applicable: � <br /> • Properry Lines • Centedine ol street � <br /> • Outline and dimensions ol all eaisting and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities � • Show measuremenis � <br /> DO IJpT WRITE BELOW TNIS LINE O <br /> PERMIT CONDITIONS <br /> 1. A�I calls lor inspection shall be made 24 hrs. in ativance•phone 259•8815. � <br /> 2. All work shall be performed in accordance with Ihis permil and current City ol Everetl Design and Construction <br /> Standerds and Specilications <br /> 3. Call location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER �•$00•424•5555. � <br /> �/o � JVI�=�F� <br /> O <br /> �•B_/.il GcJ�f:�.s �'���,�� �c���T ,`.'-G'�ii,c'Fn r" ' <br /> y �y- 8� � <br /> •-�.��1 O � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownedapplicant hereby agrees to hold ar�d save harm� <br /> less the City ol @verett Irom any and all claims lor damages, costs, <br /> ezpenses, or causes ot action that may arise because of insfallation <br /> and maintenance of Ihe improvement or other r.ghl-obway use herelo <br /> applied for and lurther agrees to remove same upon notice Irom Ihe <br /> Approved lor Conslruction Date City and to rer lace pu6lic property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Consiructetl Signature of Applicant Dale <br /> everen PUBLIC WORKS DEPARTMENT Vd�RK AUTHORIZE� BY THIS PERMIT MUST BE STApTED WITHIN <br /> � 3200Ceda�Sireet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAV BE <br /> Phone: 259-0815 CANCEILED BY TI1E CITY UPON ANY STOPPAG[OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />