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' 1 <br /> / ' <br /> Date (e/ ___ Punut Woks Permit 7 <br /> Application For Bldg.Deor. <br /> PUBLIC WORKS PERMIT PubIHWorks FN <br /> Tol•I Fee t{ <br /> Leu•PPL Fee P•.d s <br /> Print or Type Only Balance Due <br /> Sd51_ $�/ <br /> 0-x-naqm1cr\ lAames /5L72 -40'``'� 9/dn ed 1,'edm(fdl /��2 <br /> Owner Melling Address City Zip Phone <br /> Saryy, <br /> Applicant Melling Address City Zip Phone <br /> �/ p. I <br /> Describe Proposed Work —All le x 1!- efi F1 Tl� 00191ZJ <br /> i <br /> W <br /> Project Address(if known) _728��L3rO <br /> Attach four(4)copies of plans for proposed work•Draw to scale and note the following as applicable: <br /> • Property Lines • Centerline of street /A <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 /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS <br /> 1.All calls for Inspection shall be made 24 hrs,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 /> f3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1.800.424.5555. <br /> 1 <br /> I O <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> 1^� The undersigned owner/applicant 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 righhol•way use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> Approved for Co rtruc�h/on Date <br /> City and to lace public p magetl thereby. <br /> Fl LINSPECTION Date <br /> Approved as Constructed Signature of Applicant Dale <br /> everetl PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO j <br /> Everett.WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:2598810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br /> I <br />