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r _ <br /> 9 <br /> Date Publrc Worke Parmu• <br /> I Application For Brno Dear •—_ <br /> PUBLIC 'WORKS PERMIT Public Works Fee <br /> Talai Fee <br /> Leu xPPL Fee Pod B <br /> Print or Type Only 1 Belence Due <br /> AUZ T <br /> e�IJ ' JF�yI /1�onD�}n►^C�t��� ��J �Nt-. 17/ -ds�a_ <br /> 2-:51 / �wr� 7 / GG7 rest jl0 • 900 ley Zip Phone <br /> Applicant Mailing Address I City <br /> � Phone <br /> -- <br /> D scribe Proposed Work r P ,/�(] F1/�7� f�AG(,R-!1 1 W F 14 AT F, :S-Fj10 <br /> SAN i7—FAP-!4 55,tA.;ER DAl :SITE An7?) Jill Pq%gUG 2ffaNT-yG-w'A <br /> AT b pOS 50. -f 3 IlA✓ . FAIEROME <br /> � <br /> Project Addre%s lit known) JV'OC i� <br /> Attach lour(4)copies of plans for proposed work- DrP.w to scale and note the following as applicable: <br /> • Property Lines • Centerline of street w <br /> • Outline and dimensions of all existing and • Indicate North j <br /> proposed structures on the lot • Show any proposed grading changes <br /> O Existing and proposed utilities • Show measurements <br /> 00 NOT WHITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 his, in advance• phone 259.8815, <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 46 hrs. before you dig.TOLL FREE NUMBER 1-800.424.555555.. z <br /> _/ <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/appiicanl 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 /> -- nd <br /> ante of the improvement or other right-of-way use hereto <br /> an further agrees to remove same upon notice from the <br /> Appr ed r ons tion Dae e ce public property damaged thereby. <br /> FINAL IN9PECTIo <br /> N Date <br /> Approved as Conatrucled S g ature f App ant Deta <br /> PUBLIC WORKS D�EArTMENT WORK AUTHORIZ THIS PE IT MUST 8E STAr TED WITHIN <br /> 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION 7HIu PERMIT MAY BE <br /> everett <br /> Phone: 259.8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />