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Date*9_07 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />melum <br />Owner <br />^.blue Works Pelmll • 8 <br />Bldg. Dap! A <br />Public WOIka Fee S <br />Tolal Fee <br />Lost AppL FM PAW <br />Balance Due <br />r 22 Bc+k 59 2 LI< sloven <br />9d_asd' (ns3-aaaS <br />Address <br />Zip <br />_'%,17C Zip Phone <br />Applicant Mailing Address City <br />Describe P(OP3sed Work <br />W <br />70 <br />Project Address hf known) OF foe gj/r�C . <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the following as applicable: <br />sissist <br />• Property Lines • Centel line of street <br />• Outline and dimensions of all existing and • Indicate North <br />• Show any proposed grading changes <br />proposed structures on the lot <br />• Existing and proposed utilities • Show measurements <br />ca <br />DO NOT WRITE BELOW THIS LINE <br />O 0 <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. In advance • phone 259.881 5 <br />current City of Everett Design and Construction <br />2. All work shall be performed in accordance with this permit and <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig TOLL FREE NUMPeiR 1.800.424.5555. <br />siDEeeJFieK /s dE,✓ If /�N81'd4F"J • 9IDA-' e9n/T MUST <br />O <br />,�ePA/e i%✓f/ 'W1n/16,r LiO�/6 7Ei T% <br />S" 61 r 4e1;,f1Ea,,,Ay ea,— <br />�.. <br />��QAOE LoT Sa r9S /Vor %cn I/ny9CT fJQTo/n/,icLh. <br />L07S GJ/T/l /�M/k. Me '(11'41'0/9`, <br />O <br />ri1 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />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 />�+ /J and applied <br />for and <br />of the Improvement or v other rlghton notice <br />use hereto <br />cj7pty�� applied for end further agrees to remove same upon notice from the <br />pproved for Construe on Date City and to replace public property damaged thereby. <br />�_1�1. dT <br />INAL INSPECTION 0 Dal <br />pproved as Constructs Signature O pplicant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />a <br />PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUEU AND THEREAFTER IS TO <br />3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />[VOO <br />Everett, WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone: 259484PROJECT OVER 90 DAYS DURATION. <br />