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Date , `�/ " � PubLc WorhS Permil• <br /> eiao.neoi.. � _ ��n�� <br /> Applicalion For � <br /> PUBLIC WORKS PERMIT '°°To�aFoeFoo S � <br /> Less AOPI.Feo Pe�tl � <br /> ealance Dua S <br /> Print or Type Only <br /> ��o//ar �2c�e%rr�e��f ��D�yl��h S. � lL,�er��r�/, �.�G�U - <br /> Owner Mailing Address City Zip Phone <br /> ,B�- � �"�u�P • �v � /9�03/L�fh ���e.S, J��c�f/e 9�/�� ��3-i��is— <br /> Applicant � Mailing Address City Zip Phone <br /> Describe Proposed Work <br /> W <br /> Pwject Address(it known) � <br /> Attach four(4) copies of plans(or proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all exisling and • Indicate North <br /> proposed 5tructures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilitles • Show measurements /M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t. All calls for inspection shall be made 24 hrs. in advance-phone 259•881 5. � <br /> 2. All work shall be pertormed in accordance with Ihis permit and current City ot Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> �7j�C�C G�O/_',Cs' /�E�'ir.�.% �c,c'E,9of/ /ssc%Et� O <br /> .���uG <br /> ���� � <br /> � <br /> O <br /> a <br /> ACKNOWLEOGEMENT OF CONDITIONS <br /> The undersignad owner/applicanl hereby agrees to huld and save harm- <br /> —� less the City of Everett from any and all claims for damages, costs, <br /> ezpenses, or causes of action Ihat may arise because ot installation <br /> and maintenance of the improvement or other righFoFway use hereto <br /> applied for and lurlher agrees to remove same upon notice irom the <br /> � Approved For Construction �a�e City and to replace public property damaged Ihereby. <br /> FIIJAL INSPECTION Dafe <br /> Approved as Consiructed Signature of Applicanl Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMI7 MAY BE <br /> Everetl,WA 98201 CANCE:LLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 pROJL"CT OVER 90 DAYS DURATION. <br />