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2-��-$a '� C ' <br /> Date ` PuoucWo�xsPermn. <br /> Application For eioo oeo�.• 3 <br /> PUBLIC WORKS PERMIT PuoucWorksFee <br /> To1el fae s <br /> less ADDI Fee Pa�E � <br /> Print or Type Only BeianceDue s _ <br /> �?�1.Yll�'��5�►1 ����C3�'�f� v�1,� l___T_�l:p�- <br /> Owner Mailing Address Cily Zip Phone <br /> ,� ��� I `r��I � 1 I R�l__4�l �, / �� <br /> R� <br /> Applicant MaJing Address City 2ip Phone <br /> Describe Proposed Work �('V*v�� I �l� <br /> Prolect Address�il known) I C�lJF 1 t�v L Jv�f l�y� � <br /> � <br /> Attach four(4)copies of plans lor proposed worA- Draw to scale and note the foilowing as applicable: � <br /> • Property Lines • Cenlerline ol streel � <br /> • Outline and dimensions oi all existing antl • Indicate Ncr�h <br /> proposetl struetures on Ihe lo� • Show any proposed grading changes <br /> • Exisling and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All cells for inspection shall be mede 24 hrs.in advance-phone 259•8810. � ' <br /> 2.All work shell be pertormed in accordance with this permit and curcent City of Everett Design and Construction <br /> Standards and Specifications. I <br /> 3.Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � ��1,1 � ;�� � Z 2 88 O <br /> `���v""' / / <br /> � <br /> � <br /> O <br /> a <br /> I ACKNOWLEDGEMENT OF CONDITIONS <br />� The undersigned owne�/applicant heieby agrees to hoid and save harm- <br /> less the City ol Everett trom any and all claims for damages. cosis, <br /> expenses, or causes ol action that may erise because of inslallalion <br /> and maintenance o( the improvemenl or other righ�-ol-way use here�o <br /> Approved for Construction Date applied tor and furiher agrees to r^move same upon netice Irom the <br /> City and�o replace public property damaged Ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol ApFlicant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreel 18D DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everet4 WA 9820� BE DILIGFNTLY PURSUED TO COMPLETION. THIS PERMIT MA\' �[ <br /> Phone:259-8810 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT GVER 90 DAYS DURATION. I <br />