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� , <br /> Date�� t Pu�lic WoekS Peg7� <br /> � e�ec.oea�.—"r— <br /> Appiication For <br /> PUBLIC WORKS PERMIT PUOTaIaIFaoFee 5 <br /> Lesa AOV�Fee PaiO $ <br /> Balance Due + <br /> Print cr Type Only //53" <br /> "-7 <br /> --r.�... .,,.,,���'�1L.j DS�"' /�U� u��= L�l, ,�r fP��P�l.l� q�y � _ <br /> Owner Mailing Address City 7ip Phone <br /> �����P�x � ►��1 �u�. , i,�.� �� �s�- ��-7 <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work _;y� �Nl —`*"'� <br /> W <br /> � -- I�- <br /> Project Address(if known) <br /> Atlach four(4)copies of plans for Proposed worlc• Draw o scale and note the lollowing a�applicable: � <br /> • Property Lines , • Centedine of sireel � <br /> • Outline and dimensions of all existing anA • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing end proposed utllities • Show measurements M <br /> W <br /> � DO NOT WRITE BELOW THIS LINE O <br /> 1 <br /> PERMIT CUNDITIONS <br /> � 1. All cells for inspection shall 6e made 24 hrs. in advance•ahone 259•881 5. � <br /> 2. All work shall be pertonned in accordance with ihis perrnit and current Ciry of Eierett Design and Constructlon <br /> � Standards and Specificatlons. <br /> ! 3. Call Location Underground Ssrvice 48 hrs.before you dig.TOLL FIiEE NUMBER 1•800-424�5555. � <br /> , O <br /> �BLiG LiJa�.�s ��'e.•miT �+l�' ,�E�i,e€� <br /> s �-j�2�8i � <br /> 7-z�= N <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CnNDITIONS <br /> The undersigned owner/applicar�t hereby agrees to hold and yave harm• <br /> less the City of Everett from any and all claims tor damages, co�ls, <br /> expenses, or causes of action that may arfse because oi installation <br /> and maintenunce ol lhe improvement or o�har right-obway use nereto <br /> applied lor and further agrees to remove same upon notice trom the <br /> . Approved for Construction Date City and to replace public Rroperly damaged there6y. <br /> FINAL INSPECTION i-���-� Date <br /> Approved es Constructed � Signature o(Applicant <br /> WORK AUTHOFIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 1g0 DAYS OF UATE PERMIT IS ISSI;ED AN7 THEREAFTEFl IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUE� TO COMPLFTION.THIS PtRMdT MAY BE <br /> Evere�t,WA 98201 CANCELLED BY THE CITY UPON ADJY STOPPAGE OF WORK UN THIS <br /> Phone: 259-Bfi15 PROJECT OVER 90 DAYS DURATION. <br />