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-- --_ �-, ^ <br /> �BtQ_`_/ • _ �/ � Puphc WOMs Permu n• <br /> i Application For emo o�c�.. ri�(o �,�doZ� <br /> i <br /> PUBLIC WORKS PERMIT P�eTotelFeeFeO : <br /> . lecs AOD�Fee Paia S <br /> Print Of Type Only e.�.��eo�e S <br /> � Owner MaiNngAdtlress City ip Phone 4` J � <br /> �f�. <br /> Applicant Mailing Address City ZiF Phone <br /> Describe P�oposed Work R lYri`I= ((�/(A/�nY/ D <br /> Project Address(if known) � <br /> Attach four(4)copies ol plans for proposed work• Draw to scale and npte the ollowing as applicable: � <br /> • Property Lines � <br /> • Centerline ol street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Exisling and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259-881 S. <br /> 2. Ail work shall be performed in accordance wilh Ihis permit and currenl City of EvereU Design and Construction ' <br /> Standsrds and Specificatinns. <br /> � 3. Call Location UndergrounJ Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> ^ �//B� � <br /> �O ��J /�c2rn� r ,�Eq��,�En O <br /> %�� <br /> � <br /> � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownei/applicant hereby agrees to hold and save harm• <br /> less ihe Ciry of Everetl Irom any and all claims for damages. costs, <br /> expenses, or causes of action Ihat may arise because ol installatien <br /> and maintenance of Ihe improvement or other right-ol-way use here,o <br />� Approved for Construcho� pa1e applied for and further agrees to remove same upon notice Irom the <br /> Ciry and to replace public property damaged tyereby. <br /> FINAL INSPECTION Date <br /> Approved as Conshucted Signature ol Applicant Date <br /> everelt PUBLIC WORKS DEPARTMENT WORK AUTHORIZED DY THIS PERMIT MUST BE STARTED WITHiN <br /> � 3200 Cedar Street 180 DAYS OF DA7E PERMIT IS ISSUSD AND THEREA"rTER IS TO <br /> Everet�, WA 98201 BE DILIGENTLY PURSUED TO COM17PLETIUN. THIS PE-RMIT MAY 13E <br /> Phone: 259�8815 CANCELLED BV THE CITY UFON ANY STOPPAGE OF WORK ON TFIS <br /> PROJECT OVER 90 DAYS DUR,�TION. <br />