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Date--- -- <br />1# IPupuc Worke Permit • �� <br />Bldg Dept a _- <br />Application ro-9 <br />PUBLIC WORK <br />Print or Type Only <br />H <br />- 0 C n <br />Applicant <br />Describe Proposed Work <br />Protect Address (l known) <br />PERMIT I <br />C1 8 <br />N M <br />City Zip <br />AZ 9a <br />0.NLc Worts Fee is <br />�J � F — <br />toter Fee — T - <br />Less itopl Fee Pem S— <br />eednce Due S— <br />L/ <br />0 535-� S iL <br />to Phone <br />I Kr let, S fa-/!�S V- it rook %O S41l40') _5;41j��7�- <br />Attach lour 141 copies of plans lot proposed work • Draw to scale and note the following as applicable <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />I All calls for inspection shall be mode le. his. In advance • phone 259.8810. <br />2. All work shoo) be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />9 Call Location Underground Service 48 hrsbefore you dig. TOLL FREE NUMBER 1.800.424.5555. <br />.40-4-V a/P� or/ CA-,, /./01411C <br />wmMl PUBLIC WORKSDEPARIMENt <br />J200tt,WA Strom <br />Evetatt, WA 9ero+ <br />Phone. 2s9 bolo <br />d^14e� lZ-s'-Pre <br />W <br />H <br />ca <br />O <br />M) <br />z <br />O <br />O <br />a <br />ACKNOWLEDOEMENT OF CONDITIONS <br />The undersigned owaeUapplicanl hereby agrees to hold and rave harm• <br />saris the City Of Elar all from any and all dlsms lot domag@L 00619 <br />expenries. or causes of action that may allsa because of Installation <br />and maintenance of the IMProvamant of other nphl•ofwvay, use helafo <br />applied for and further agree$ to famove ama upon notion prom the <br />City and to replace, public ptoparly damaged thereby. <br />n f a nl ale <br />Igo DAYSOFDATE pERMIT19 ISSUED rAND THE BAFTEN 10 10 <br />BE OILIGENILY PURBUtO TO COMPLETION, TI/IB PERMIT MAY DH <br />CANCELLED BY THE CITY UPON ANY STOPPAGE Or WORK ON Tf119 <br />PNOJEOT OVE1190 DAYS DURATION <br />