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D'ate�, � p p�nim�vorks vermit. p <br /> Application For � eioo.oePi.. �7�� �p L1 Z <br /> P��i�l� WORKS PERMIT Pu01iCWork�Po< <br /> Total Fee S <br /> Losa Appl Fee Peltl S <br /> Bnienca Due F <br /> Print or Type Only <br /> Sm d[ � 1' n� <br /> CR1J]f N �S 1�" ��Jt���n, P 7•� ?��.. E'vP/ �r/���c�Q���—�7�� <br /> Owner Mailing Address City Zip Phone <br /> �Ap�nt ;A3�ling Addr65s City Zip phone <br /> Describe ProposeA Work _�5��;�f•1. n��/�A1 L��t T� _ <br /> _7.. <br /> ���� __ --- W <br /> Prolecf Aadress(if known) �_� �f/L�/ 7T' /� � <br /> Attach taur(4)copies ol plans for proposed work- Oraw to scale and note the f�llowing as applicable: � <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimensions of ail existing and • Indicate North � <br /> proposed st�uctures on the lot C ch�w any proposed grading changes <br /> • Eziating and proposed utili;ies • Show measurements � <br /> DO NOT�YRITE BELOW Tl11S LINE � <br /> PERMIT CONDITIONS <br /> 1. �II calls for Inspection shall 6e made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be periormed in accordance with this permit and current City of Everetf Oesign and Cunstruction <br /> Standards and Specificatlona <br /> 3. Cell Location Underground Service 48 hra before you dig.TOLI FREE NUMBER 1-BQO-424•5555. � <br /> f��i��:c �o,e,� ,�c-;e.���T �'✓or �f'F��i,:�E� s�'z�87 O <br /> ' /" � � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> _ The undersigned owner,�apFUcant hereby agrees to hold and save harm- <br /> — less the City of EvereL' irom any and all claims tor damagec, costs, <br /> expenses, or causes ol action that may erise because of instaltation <br /> and maintenance of the improvemenl or other righFof-way use hereto <br /> Approvetl!orConstruction applied for and further agrees to remove same upon notice irom the <br /> �°�' City and lo replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Dete <br /> everett PU6LIC WORKS UEPARI�MENT ��'GHK AUTHORIZED B`.' THIS PEiIMIT MUST BE STAFiTED WITH�N <br /> � 3200CedarStreet 1d0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTFR IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLE?ION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON 1 HIS <br /> PROJECT OVER 90 DAYS DURATION. <br />