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/ -�"f <br /> oace '- 9 �'6 PuELc Work�Peemit• ��'�/ <br /> Applicatioo For e�ao.oeo�.• <br /> PU�L.IC WO�SKS PERMIT PUOToInIFee`�e s — <br /> Lass RD��Fea PaiE S—__ <br /> Balanca Oue s �U � <br /> Print or Type Only <br /> C o I,t/x /✓ <.,�lj���y ,,�3 ��..l�� ��I���",l�f�� ��� � � 3.�s-��� � <br /> Owner Mailing Address City 2ip Phone <br /> ��_ <br /> Applicerit Mailin;Address City Zip Phone <br /> Deatribe Proposed Work ���� �E�/�^rl ��vJ/ .��(Z/� .�u��'N J�e.c F �v <br /> �'/�-' o j°,,f'fi,'1-1_ �' /Y'1—^ <br /> . W <br /> Project Address(if known) � �— �����'- ��G �� � <br /> Attaeh four(4)copies of plens tor proposed work• Draw to scale and note the�ollowing as appliceble: � <br /> • Property Lines • Conterline of sireet � <br /> • Outline and dimensions of all existing and • In+icate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PEHMIT CONDITIONS <br /> 1. All calls tor inspection shell be made 24 hrs in advance- phone 259•8815. � <br /> 2. All work shell be peAormed in accordance with ihis permit and current Cily of Everett Design and Conctructlon <br /> Standards end Specifications. <br /> 3. Cell Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> /. ST.C'FET T BE f'�C�lf/EU �F•E �iTy O <br /> ST�r.vO._' -.�c� f�,�/H <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersgned owner/applicant hereby agrees to hold and save harm- <br /> less the Ciry of Everett from any and all claims for damages, cosis, <br /> � j expenses, or causes ol action Ihat may arise because of installation <br /> ��'���'C✓l%���' ��y��U and maintenance ol Ihe improvement or olher righ4of-way use hereto <br /> applied lor and lurther agrees to remove same upon notice irom the <br /> Approved for^ nsiruction Dale Cily and to replace public property damaged thereby. <br /> �SL ��,,,�., ��r til�� �� c, �� c � .2 9 � <br /> FINAL INSPECTION � Date ' ���f> �� <br /> Approved as Construc� Signature� ol App ic� Date <br /> evere[t PUBLIC WORKS DEPARTMENT WORK AI�THORIZED' THIS PERMIT ST BE STARTED WITHIN <br /> O 3200CedarStreet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-BA15 CANCEILED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJ[CT OVER 90 DAYS DURATION. <br />