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4y to <br />Y L8ld9'CD§P*1f <br />ks Per It .L� <br />Date • e�(I_7Application For <br />" Fee <br />PUBLIC WORKS PERMIT ee <br />Fee Paid $ue • <br />Print or Type Cnly 70�� <br />\O ,eir1 —Milling Address <br />City Zlp Phc le <br />y t rM a City Zip Phone <br />Applicant Mailing Address z <br />0 <br />H <br />r.. <br />f"1 <br />Describe Proposed Work <br />L / NLQ Nm <br />��� 5ing E <br />Project Address (If known) o <br />ing as ap <br />Attach four (4) copies of plans (or proposed work • Draw to scale end note the aniterline of streetas <br />able: (i/ 3 <br />• Property Lines • Indicate North <br />• Outline and dimensions ci all existing and m <br />proposed structures on the Ict • Show any proposed grading changes .-, <br />• Show measurements Q z <br />• Existing and proposed utllPi-'s y� <br />i~ <br />DO NOT WRITE BELOW THIS LINE /� _ <br />v Y <br />—I n <br />PERMIT CONDITIONSr, X <br />1. All calls for Inspection shell be 1 jade 24 hra 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 Speciflcatlona m r- <br />3. Call Location Underground Service 48 his. before you dig. TOLL FREE NUMBER 1.800.424.5555. N <br />/ate = m <br />(`w/1 c rn <br />a c, <br />A <br />A <br />® •l <br />S <br />a <br />r'1 <br />for <br />Approved es Constructed H <br />(J <br />c <br />rell PUBLIC WORKDEPARTMENT <br />treet <br />Ever Cedar 8201 <br />Everett, a 98201 <br />Phone: 259.6815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/appircant hereby agrees 10 hold and save harm- <br />less the City of Everett from any and all claims for damages, Costa <br />expenses, or causes of action that may arise because of installation <br />and improvement or <br />e hereto <br />applied ifor and furthntenance of eragreesother <br />agrees to rremove sameu t 9 <br />Ponnotice from the <br />City and to reViace ptAlic property damaged thereby. / <br />4 <br />Date T� Date <br />LIST <br />Si store of Applicant BE STARTED <br />80RDAYS OFF DATE PERM T IS ISSUED AND THE THEREAFTER ISTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUFrATION. <br />