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DeteiS G D J ��( 7 PueiK wore�Pe mn• �� 2 <br /> Application For Bldg Dapr.e <br /> PUBLIC WORKS PERMIT °;Total ° <br /> Leu Appl Fee Paid • <br /> O <br /> 3 � <br /> Print or Type Only Balance Due <br /> ,f/,O <br /> PE�ir fEE �o oN <br /> �a sy_3o7 <br /> S70WPIO -E CQ S�yS—i0� �IU� n ��tvu ` C1 )'cls-4sr-ok44 <br /> Owner Melling Address City Zip Phone <br /> z <br /> Applicant '���' ''//'' Mailing Address City Zip Phone m <br /> V <br /> Describe Proposed Work U) L)u I U4W`k. (YU 7 7 � L C Z0T I R) Ck 012 <br /> In x <br /> _ o <br /> m <br /> cv <br /> rn n <br /> —1 c <br /> Protect Address(if known) .JQ7 7 <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note the following as applicable: pxn~ <br /> • Property Lines • Ce,derline of street ♦^ 0 = <br /> • Outline and dimensions of all existing and • Indicate North v♦ <br /> proposed etruclures on the lot • Show any proposed grading changes .~z.. <br /> • Existing and proposed utilities • Show measurements M -4 v, <br /> W � <br /> T <br /> DO NOT WRITE BELOW THIS LINEO -n A <br /> PERMIT CONDITIONS —1 FFF�riii <br /> x <br /> 1. All calls for Inspection shrill be made 24 hire, In advance- phone 259-8815. <br /> 2. All work shall be performed in accordance with this permit and current City of I=veael l Design and Constnn n, ioo <br /> Standards and Specifications, <br /> 3. Call Location Underground Service 48 hrs,before you dig. TOLL FREE NUMBER 1.800.424.5555. iA N <br /> :4 m <br /> IW" �t-QNJOt/� �7(/S�ini/ C!Y/(fPLthZ/ Cln� d r,Q.. G(/i/- O a <br /> I I�' 9 I C v I'� q✓ xz --d Se de awloG/ ,,ii <br /> CIO <br /> �/ � �l�.e-w- c�v'r rre� �.wr �r•a e.�r�-�i cry, r1 .E r� S1`�D '�3dJ <br /> 2p A <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrues 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 /> andmain) iAance of the improvement or other right-of-way use hereto <br /> applied I end fu her ee jo remove same upon notice from the <br /> Approved for Constr ion Date City and oreply p li pr Fy damaged thereby. <br /> i <br /> FINAL INSPECTION Date <br /> Approved as Constructed Sighatur4f6f Applicant Gate <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200 Cedar Street BE DAYS DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett.WA 98201 BE <br /> Phone: 259.8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />