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<br /> p m ' Applicant Mailin9 Address
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<br /> f � H N �''I Describe ProPosed Work � � I
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<br /> Proiect Address(il known) `�' - � ��
<br /> � Attach four(4)copies of plans for proposed work'- Draw to scale�and nole�e�QoI1eW'ne of stPeet able: - �
<br /> � • Property Lines , i d • Indicate Norih
<br /> . and dimensions of all exist�n� a radin changes
<br /> • Oulline • Show any proposed g 9
<br /> �. proposed sirucWres on the lot � Show measurements
<br /> r Existing and proposetl utilities �
<br /> DO NOT WRIiE BELOW THIS LINE �
<br /> ' .r� .. " PERMITCONDITIONS �
<br /> � �w ' � 1.All calls br inspection shall be made 24 hrs.in advance-phone 259-8810.
<br /> � 2.All work shall be pedormed in accordance with this permit and current Ciry of Everetl Design and Construclion �
<br /> , � ' Sl2ndards and Specilications. ai'
<br /> I 3.Call Location Underground Service 48 hrs.before you di9.TOLL FREE NUMBER 1-500-424-5555. i
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<br /> ACKNOWLEDGEMENT OF CONDITIONS
<br /> , , li The undersigned owner/aUPlicant hereby agrees to hold and save harm�
<br /> '_ I _ ✓ less Ihe Cily of Everett Irom any and all claims lor damayes, costs.
<br /> � _ expenses, or causes ol action that may arise because ol installalion
<br /> o�� I and mainlenance of ihc improvement or other ri9h4ol-way use herelo
<br /> _. I � . __l� ���� ��`- ' �a�� c:. ��� applied for and lurther agrees to remove same upon nutice Ira� the
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<br /> Date City and lo replace public properry damaged Ihereby.
<br /> � qpprove��iqr Construction �/ � �
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<br /> . Date ' " � ��- �
<br /> � FINAL INSPECTION ' Si9naturo bl Appliq nt Date
<br /> I qpproved asConstructed WORK AUTHORIZED BY THIS PERMIT MUST BE S7ARTED WITHIN
<br /> � �> ?UBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO
<br /> , ,�Q� 3200 Cedar Slreet BE DILIGENTLV PURSUFD TO COMPLETION.THIS PERMIT MAY BE
<br /> Everell,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON Th115
<br /> , � Phone:259�B810 PROJECT OVER 90 DAYS DUR�TION.
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