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Date <br /> Nubi¢Wbrks Permit a <br /> Application For Bi0p.0eo�.+_ ._ <br /> PllBLIC WORKS �ERMIT PVbTaialFeoFoe s <br /> Less Fppl.Fee PaiO �J <br /> Print orType Only o=�.,����o„� s <br /> G� � ��/AuKM Y�� � I � !/lf �c' <br /> ..�'-r i t.� Ge� �- �s.�n � <br /> Owner Mailing Address Gty Zip Phone <br /> �-� ��`9s� �� j�%L`-3 L`�/3s�= /�i��t�.�eo /ti�9' .C�'L7z 7%Y-6��,// <br /> � Applicant Maihng Address Cily Zip Phone <br /> Describe Proposed Work /�d���� <br /> Projecl Address(if known) ,/�2 3 — J�7 ��JmOa•// X � <br /> Attach four(4)copies of Glans lor proposed work- Draw to scale and note Ihe lollowing as applicable: � <br /> O Property Lines • Centerline ol sireet <br /> • Outlir.e and dimensions of all existing and • Indicale North ��! <br /> proposed structures on the lot • Show any prop�sed grading changes <br /> • Existing and proposed utilities • Show measuremerits � <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-$$1 5. � <br /> 2. All work shall be performed in accordance with this permit and current City ol Everett Design and Consiruclion <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> ' �n � - w � <br /> � � � , <br /> / �� r i �' <br /> i� � � <br /> T` � � <br /> � <br /> ACKNOWLE�c;EMENT OF CONDITIONS <br /> The undersigned owner/applicant heieby agrees tu hold an�save harm� <br /> less ihe City of EvereU irom 2ny and all claims lor damages. cosls, <br /> expenses, or causes ot action thal may arise because of installation <br /> and maintenance of the improvement or other right�ol-way use hereto <br /> applied lor and furiher agrees to remove same upon notice f�om ihe <br /> Approved for Construction Date City and to replace public properry darr�aged thereby. <br /> FINAL WSPECI'ION Da�e ' �� <br /> Approved as Constructed Signature ot Applicanl Date ��j <br /> I � <br /> everett PUBLIC WOFKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHI�' . I <br /> � 3200CedarStreel 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TC�� <br /> Everett, WA 98201 8E UILIGENTLY PURSUED TO COMPLETION. THIS PERIdIT MAY 8!' <br /> I Phone: 259-E381 5 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIi< <br /> PROJECT OVER 90 DAYS DURATION. I I <br /> I i <br />` <br />