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. .__-_-- - -. -._...�—"..._. <br /> Date��C _. � r�nec wo,r.:ae���i�. �'�7��_ j'J <br /> Application For ema�oeoi.•���Jl�° <br /> PUBLIC WORKS PERMIT PuelicWo.kaFee <br /> To�eiPoe s <br /> Lese�OP��Fee Pe�iE S <br /> Print or Type Only ee�e��ao�e s <br /> T�r�'I�i�'�� �'r�F' L1�(i2in� 171g ��CAI.�'�cJAt/ �'i, �'r'�f <br /> Owner Mailing Address Ciry Zip ��one <br /> 9�,��1 <br /> Applicant Mailing Address Cily Zip Phone <br /> Describe Proposed Work ���� � ��—� )�� -��f7� J __ <br /> , � � W <br /> Prolect Address(il known) � � <br /> Attach lour(4)copies of plans for proposed work- Draw to scale and note e lollowing as applicable: � <br /> • Property Lines • Centerline of streel � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed slructures on the lot • Show any proposed grading chTnges <br /> • Ezisting and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW TH�S LINE O <br /> PERMIT CONDITIONS <br /> 1.All celis for Inspeclion shall be made 2a hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Locatlon Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> ,� „n � .� 1� �7 � /) O <br /> / .f��-(LC lc �C't/,�1, J�� ; ».ct /cc7� �c�.�c'tc•J' <br /> / �'�!'��r-r��-� .J'-3C'�!' <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF GONDITIONS <br /> The undersigned owne�/applicant hereby agrees lo hold and save harm• <br /> less ihe City ol Ev=retl irom any and all claims for damages, cosis, <br /> ezpenses, or causes of action that may arise because of installation <br /> and maintenance of the improvemenl or ofher right-of�way use hereto <br /> applied for and lurthei agrees to remove same upon notice irom the <br /> Approved lor Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approve�as Constructed Signature ot Applicant Date <br /> everett PUBLICWORK.iDEPARTMENT WORK AUTHORI2ED BY TH�S PEtiM�T MUST BE STAi7TED WITIiIN <br /> � 3200CedarStreet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA9A201 BE DII.IGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259-8370 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS Uf1RATION. <br />