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Date�g� v„oi��wo��:rr,m i. p <br /> Applicelion For Bma 0«0� • �v�__— <br /> PUB:.IC WORKS PERMIT P�°��°W°��tFe° -- <br /> Tolel Fae S <br /> Laee AOP�fne Pe�E S <br /> Print or T7pe Only BeinnceDuc s <br /> � �n?t� 1Ja� -[OC1'k.t`�- C�� �Q' E✓P�P i.�,4 93z,; 347-//l, � <br /> wner Mailing Address City Zip Phone—T <br /> V,s}a- �'1� CP. /�i3�x�,Z9�����P�f �'��zG'� as,�-�s� vzrT/�n.,r�i�g� <br /> Appficent Meiling Addres City Zip � Phone <br /> Uescribe Proposed Work �(j�(ldP � L�(i�/1 �rl� <br /> - W <br /> , �Project Add�ess(II known) ���7 –/Q�S� .rG� �' <br /> Altach lour�4)coples ol plans lor proposed work- Draw lo scale and note the.ollowing es applicable: � <br /> • Property Lines • Centerline of streel � <br /> • Outline end dlmansions ol all existing end • Indicate North <br /> proposed structures on the lot � Jhow any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT COND�TIONS <br /> 1. All calls lor Inspectlon ahatl be made 24 his. In advence• phone 259•8815. � <br /> 2. All work shall be performed in eccordenc�with this pe�mit and currenl City ol Everett Design and Constructlon <br /> , Standerds and Specilicetlons <br /> 3. Call Locatlon Underground Service 4B h�s.5efore you dig.TOLL FREE NUMBEN 1•800•424•5555. � <br /> . ?�/ �/.S-8T O <br /> �� ��(/i/��L� !•lifi <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLED(iEMENT OF CONDITIONS <br /> The undorslgned ownei/epplicant hereby agreos to hold end seve harm� <br /> — les.: the Ciry ol Everell irom any end all claims lor demages, cosls, <br /> exponses. or ceuses ot action ihat mey arise because ol inslallation <br /> and maintonance of the irnprovemenl or other rlghPof�wey use he�eto <br /> applled lor and lurther agrees �o remove same upon notice Irom the <br /> Approved for Construcl:on Dete City and lo replace public property demageJ thereby. <br /> FINAL INSPECTION Date <br /> Approved es Consiructed Si9naWre ol Applicant Date <br /> pye�p�� PUBLIC WORKS DEPARiMENT WOPK AUTHOFIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Slreet 100 DAYS OF �ATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br /> Everelt.WA 90201 BE DII.IGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAV BE <br /> Phone�. 259-BB15 CANCELLED 9V TH[CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJEGT OVER 90 DAYS DURATION. <br />