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Date ,a_,r�"�7 •�°'°d, ,....:, a��r�wo,k:ve,mra. (� �` <br /> Bltlg.Dept a rr�] /!] � / � <br /> Application For - � <br /> PUBLIC WORKS PERMIT PUOTOIWFeo�Oe � <br /> L.•ssApOLFoePaid $ <br /> � Balance Oue $ <br /> Print or Type Only <br />�, _ (7�,e1 � 3,�7-37G5 ! <br />- �.�,✓ )t� _i�'�"�Iplbn /�!p��/Pvl C�1u:i /-. 1 / �l_�j-? n n� ,�r, ,f� �'=t/P/�1f �t�ZC� <br /> wner Mailing Address City 2ip Phone <br />..;_�,. � ��rl't�.. <br /> Applicant Mailing Address City Zip Phone <br />�', � <br /> I <br />��.,. Describe Prouosed Work ���� �/ 11 PG 1 �(�j(�./ d— vYlrn/P (L/_(} l� _ <br /> r <br /> � <br /> � <br /> I <br /> � - W ,I <br /> Prolecl Address(i(known) f.� �L1 " �� �JP •.1� �, <br /> � ' <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as appliwble: � �. <br /> • Property Lines • Centerline of streel � <br /> • Outline and dimensions of all existing and • Indicale North <br /> proposed structure;on the lot • Show any proposed grading changes <br /> • Existing and proposecl utilities • Show measurements � <br /> . DO NOT WRITE BELOW THIS LINE O . <br /> PERMIT CONDITIONS <br /> 1. Ail calls for inspeclion shall be made 24 hrs. in advance � phone 259•881 5. � .' <br /> 2. All work shall be perfomied in zce urdance with this permit and current City of Everett Design and Construction , <br /> Standards and Specifications. <br /> 3. Call Locatiun Urderground Service 48 hrs. before you di3.TOLL FREE NUMBER 1•800•424•5555. � I� <br /> � <br /> � �f�. O I <br /> /"CIBGiC GG D,E�.�s l""G_.�fe•iT /1l�G�T��.�c'yGY.P�s4 � <br /> �� /D/c97 � ' <br /> , / � <br /> ��� � <br /> � I <br /> � I <br /> I <br /> a <br /> ACKNOWLEDGEMENTOFCONDITIONS � <br /> The undersic�ned ownar/applicant hereby agrees to hold and save harm- <br /> -- less the Ciry of Everett from any and all claims for damages, costs, <br /> expenses, or causes of action thal may arise 6ecause of installation <br /> and maintenance of lhe improvement or other right-ohway use nereto <br /> applied for and furiher agrees to remove sar..e upon notice (rom ihe <br /> Approved for Construction Date City and to replace public property dama9ed thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Npplicant Date <br /> everett °USLIC WORKS DEPARTMENT WORK AL1TH0!tIZED BY THIS PERMIT MUST BE STARTED WITIiIN <br /> � 3200 Cedar Sireet 1t30 DAYS OF DATE PERMIT IS ISSUED AND 7HEREAFTER IS TO <br /> Everett,WA 98201 BE DILi�ENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 2c9-8815 CANC[LLcD BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT'�VER 90 DAYS DURATION. � <br /> �• <br /> I <br /> � <br /> � <br />