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Date��d fe <br /> Public Woiks P�rmit r <br /> ApplicationFor aiae�oeu�., ��� �7� <br /> PUBLiC WORKS PERMIT PublicWoikaFee <br /> Ta1elFee $ <br /> Less ApP�Fee Peld $ <br /> Print or Type Only e��a��ao�e S <br /> _ D�t/�, ��e u�lo,�.��.,�(� a��7G ,s� /yJ,wr��?��G� �z.3G -a� � <br /> Owner Mailing Address City Zip Phone <br /> 1�PJcdv1 � C_. b2/D`� � ( (�q r,�k�. rd�iy��'���7 <br /> Applicant Mailing A dress 7 City �ip � Phone <br /> ���)� ,( r <br /> Descri6e Proposed Work �� l 6(�/ C.(,lC.1/.(5d /_k j��/�/iv/G_ �(i � / <br /> �� <br /> Project Address(if k�iown) � � <br /> Attach tour(4)copies of plans lor proposed work- Draw to scale and note lh following as applicable: � <br /> • Property Lines • Centerline of streel � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WFITE BELOW THIS LINE O <br /> PEFMIT CONDITIONS <br /> 1. All calls tor in�pection shall be made 24 hrs. in advanr.e- phone 259-881 5. � <br /> 2. All work shall 6e perlormed in accordance with this permit and current Ciry of Everett Desi�n and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. belore you dip.TOLL FREE NUMBER 1-800•424•5555. � <br /> /G>f.�CiC C�''0.�,�5 i`��•P/���T /.�nT ,(�EnOi.��"Q O <br /> �;�-8� �, <br /> `�n� � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applican;hercby agrees to hold•and save harm- <br /> less the Cily of Everelt Irom any and all claims for damages, r.osts, <br /> expenses, or causes e! action that may arise because of installation <br /> and maintenance ol the improvement or c:her right-obway use herelo <br /> �pplied for and Wrther agrees to iemove same upon notice Irom the <br /> ApProved for Conslruction Date City and lo replace public property damaged thereby. <br /> FINAL INSPEC'iON Date <br /> Aparoved as ConsVucted . � Sinr.eture of ApplicaM Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THW PEFNIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA 98201 BE DILIGENTLY PURSUED TrJ COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259•8875 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />