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oa�e <br />PUBLIC <br />Print or Type Only <br />�escribe Proposed Work <br />v <br />APPlicalfo For <br />WOR�CS <br />O <br />� <br />d <br />�.� <br />`� 7� pnCTING I <br />f' <br />h <br />p�MIT <br />i� <br />.r'y� �•1 P� fJ S G� CJ -O <br />r-;�ri=t�i n; rJ'�� r o r[p�:�� <br />M��`t .0 ' � Ul [� <br />� =, .i��':� �Fv. <br />�iW�� <br />Lp <br />�i�c Wo�Ms oermit • �� / <br />B�ao oeo�� • --- — <br />Pue�mWo�wef�e s <br />To1�l ine _ <br />1.eea�oo�Fee1'nif s <br />Balenca Oun ` <br />Prolect Address Iil knownl ---�---� c`'�`��— -� <br />qtinch lour 14� copies of plans lor proposed work � Draw to scale and note �he loilowing as epplica6ie�. <br />• Proparly Lines <br />• Oulline end dimensions ol ell eaisting and <br />proposed structures on �he lo� <br />• Ezisling and proposed utililies <br />�07873,1n2 <br />���2,�' �--- <br />Phone <br />� Centerline ol sireel <br />• Inditate North <br />• Show anY Proptlsed greding chenge.s <br />• Show measuremenls <br />PEFMIT CONDITIONS <br />1. All calls tor inspection shell be mede 24 hrs. fn edvance • phone 259•8810. <br />2. All work ehall be performed In accordance with thla permit end current CVy ol Everett Design�end Constructlon <br />Stenderds and Specificelions. <br />3. Cell Locetion Underground Service 48 hrs. beloie you dig. TOLL FREE NUMBER 1•B00'424•555 . <br />���,-�.� � � �s <br />c%�� 3 3 -9'� <br />qpprovP.d as ConS�ruciea <br />%� PUBLIC WORKS OEPARTMEVT <br />3200 Ceder Sireet <br />Everetl. WA 9B2a1 <br />Phone: 259�BB iC <br />W <br />H <br />� <br />� <br />� <br />� <br />� <br />� <br />O <br />ACKNOWLEDGEMENT nF �ONDITIONS <br />The �ndersigned ow�edapp6cont heref <I�ees to hold and sa� e h;vm� <br />Iess Ihe Gdy ol Everetl Irom any nnri claims lor damage:�. cosls. <br />expenses. or causes ol acGon �hat m.iv anse because oi inslallation <br />and memlenance ol Ihe improvemen� o� olher righl�obwey use heretn <br />0pplicd for end lurther agrees �o ramove same upon notice from Ihe <br />C9y anA t rep e pu ic proPerry damagod Ihereby. <br />ii � � <br />Dale <br />nnWre o APPhcant <br />WORK Al17HORIZED 8Y THIS PERMIT MUST BE STARTED WI?HIN <br />1B0 �AVS OF DATE PERMIT IS ISSUED AND THEf7EAFTER IS i0 <br />BE DILIGEN7LY PURSUED TO COMPLE?ION. THIS PERMIT MAV B[ <br />PROJEGT OVEA 90 DAVS DUR T ON. ST�PPAGE GF WORK ON THIS <br />