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' P�Cuc Work�Permit• �O � <br /> Dete /�� ema oeo�.• <br /> qpplitalion For P„oiw wons Fee <br /> PUBLIC WORKS PERMIT Tot��F'se •--- - <br /> Lau ApD��ee P��� S 4 D <br /> ♦ <br /> B�i�nce Due <br /> Print or Type Only P•4i0 7�7S�e <br /> GVER� 98103 25�-265Z <br /> MADD y.�7-3 THoAISO Z�p Pnone <br /> Meiling Address ���y <br /> Owner <br /> S�ME Z�P Phone <br /> Applitant <br /> Mailing Address ���Y <br /> �" G 6 E <br /> B <br /> Describe Proposed Work <br /> PA�� �� ANv�B ��� <br /> W <br /> y2x3 T�a.r�so � <br /> Prolect Address�it known) � <br /> Attech four(4)copies of plans tor proposad work- Draw to sc�le anC note�e�e^�1eW'ne oj,PQe1 able: <br /> S Property Lines • Indicate North <br /> • Outline and dimensions ol ell existing anA � ghow a�y Proposed grading changes � <br /> proposed slrucW res on the lot � Show measurements <br /> • Existing and proposed utilities O <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspection shall be made 24 hrs. in advance- Phone 259•881 5. � <br /> 2. All work shall be Deriormed in accordance with this permit and currenl City ol Everett Design and i.onstruclion � <br /> Standards and SDecilications. � <br /> 3. Call Location Underground Service 4Ei hrs.belore You d�g.TOIL FREE NUMBER 1•800•424•555 . r <br /> O <br /> � � .F^_ <br /> N NE <br /> � C�1 �, <br /> � � c <br /> � �. <br /> � ' <br /> � ; <br /> ACKNOWIEDGEMENT OF GONDITIONS �, :�_ <br /> T'�e u�de�signea owner/apP <br /> licant hereby ag�ees to hold and save harm� � � <br /> Iess the Gny ot Everett Irom any and all claims lor Oamnges, cosls. O s <br /> eapenses, or causes ol action lhat may ariee because :� in51a11a0on <br /> and maintenance of ihe imees lo Qemove 15ame9�`�'w��Y��s�mr�he � ` <br /> � ��� �� ��� f�� apPlied lor a�d further ag �., f <br /> � Dale C�ty and to replace Public p�operly dama0ed iherebY <br /> qppmv¢d�or Constructlon � <br /> _�--� i� i/_ �� � � 9��0/�y � ` <br /> `�������„ f� - � <br /> �-- ti /'i r �J'i'I��.l�t<� uate <br /> ._-� Uate ✓ � �; ; <br /> fiNAL INSPECTION Signawre o1 APPlicant <br /> Approved as Conslrucled y�ORK AUTHORIZE� 9Y THIS PERMI7 MUST BE STARiED WITHIN <br /> everett PUBLIC WORKS DEPARTMEN7 BE DI�LIGE O LYDPURSUED lOICOMPLEDION�TH S PERMIT MAY E <br /> � 3200 Ged��Street CANCELLE�BV THE CITV UPON ANY SiOPPAGE OF WOAK CN THIS <br /> Everetl,WA 98z�� pqp,lECT OVER 50 DAVS DURATION. <br /> Phonc�. 259�8815 <br />