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�8 9 1ll ✓ <br /> bate.?-I B / Pueuc Wo.xa Permit /9• _ � <br /> Application For Bldg Dept • _ <br /> PUBLIC WORKS PERMIT PueTc TptFe41 Feeive 5 ---- <br /> e <br /> lew atwl Fee Paid S _ <br /> Print or Type Only Balerim Due <br /> ,��,r�r�ns 9� ► s7 � oto 99OV3 3y2- 'qs93 <br /> Owner Mailing Address Cliv Zip tal(,n, 4 ,72Fe 14-00dkoe <br /> Applicant Ma1fI ng Address o I,U"yy I , Zip Phone <br /> Describe Proposed Work +0 �0 0 r " V p �A` w• 'v` "�- _ __ _ <br /> LU <br /> +f Project Address of known) —�• �� <br /> SAttach four 14)copies of plans for proposed work• Draw to ale and nolo the following as applicable: <br /> • Property Lines • Centerline of street ♦yam <br /> • Outline and dimensions of all existing and • Indicate North V <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> CO <br /> DO NOT WRITE BELOW THIS LINE ` <br /> PERMIT CONDITIONS Q <br /> �. 1.All calla for inspection shall be made 24 hire,in advance•phone 259.8810. <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Cell Location Underground Service 48 his.before you dig.TOLL FREE NUMBER 1.800.424.5555. <br /> 7 �l� C/15/ ST.c'P7TJ'4 4CIO-Ay✓ AT A![ ji/17�.T O <br /> k <br /> �- Pjraaloo� h'rr/� 41eFc74P <br /> Ri/ TNS Girt/ HIdUL L�bC'tf In/SPfGToR. �o <br /> 3. 7 C <br /> 0^ <br /> r'• <br /> �f Q� ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownertapplicant hereby agrees to hold and save harm• <br /> less the City of Everett from any and all claims for damages. costs. <br /> / expenses, or causes of action that may arise because of Installation <br /> and maintenance of the Improvement or other right-of-way use hereto <br /> ���LLL [moi applied further agrees to remove same upon notice from the <br /> Approved for Conue jw strDate City d to r lace pWprop dam thereby. <br /> t or �' fJ <br /> FINAL INSPECTION DateL4 44 <br /> Approved as Constructed ignature of Applica Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> .1200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259.8810 PROJECT OVER 90 DAYS DURATION. <br />