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� � 9 <br /> Date /�� Public WorNs Permit• ��—��• <br /> ApplicatiorFor eme�oep�.s } � _ <br /> PUBLlC WO�KS P�FiN91T PublieWorksFee <br /> Totel Fee s <br /> Less AppL Fee PaiG S <br /> BalancuOue s •�O�O <br /> Print or Type Only — <br /> 0"�'o.>�Pr �n �C ,''7l -.�5�?5 <br /> Owner Mailing Address City Zip � �� Phon� <br /> ,�HPt�FINP-, C�u,�`1N�. i�i� �Uo��_r�o,1t�- ��oy �3� -�iiy_ <br /> Applicant Nailing Address City Zip Phor.e <br /> Describe Proposed Work /1J PN) /'�r'Si�Pvr cN. <br /> ProjectAddress(if known� %9is- �5-��h.t�G'C� �i <<'T lc'-S^h'G � <br /> /1 � <br /> Attach four(4)copies of plar.s for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centeriine of street � <br /> • Outline and dimensions of all existing and • �ndicate North <br /> proposed structuras on the lot • Show any proposed grading changes <br /> • Existing and ?rcposed utildies • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> t. All calis tor inspection shall be made 2a hrs. in advance- phone 259-981 5. � <br /> 2. All work shall be performed in accordance witn this permit and current Cily ot Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 his. before you dig.TOLL FREE NUMBER 1-800-424•5535. � <br /> O <br />' � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CnNDIT10NS <br /> Tlie undersign�d owner/�pplicant here:by agrees to hold and save harm- <br /> — --� less the Cily of Everett From any and all claims for damagas, costs, <br /> � / expenses, or causes of action that may arise because of installation <br /> I�.� ��c�� �1_y �y� and maintenance of the improvement or oiher right-of-way use hereto <br /> applied for and Ivrther agrees to remove seme upon notice from the <br /> AFProved for onstruction Date ;,ity and to replace public property damaged thereby. <br /> //%3/� <iG�� �-/7-`j � <br /> FIN`AL INSPECTION Date S � <br /> Approved as Constructed gnature of pplican " Data <br /> everet[ PUBLI(;WORKS DEPARTMENT ORK AUTHORIZED B THIS RMIT titUST BE STARTED WITHIN <br /> � 3200CedarStreel 180 UAYS OF DATE PERMIT IS ISSUED AND THEREAFTER �S TO <br /> Everett,WA 98201 BE DILIGENiLY PURSUED TO COMPLETION. THIS FERMIT MAY BE <br /> Phone:259-8815 CANCELLED BY THE CITl'UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 9� DAYS UURATION. <br />