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Date�' 7 r� <br /> � � �Pu�lic Work�Perm� • <br /> Application For eiep Dao�.e �—����o.� <br /> PUBLIC WORICS PERMIT PubbcWork�Fee <br /> Total Fne s <br /> leeaAppl.Fee PaiE S <br /> Print or Type Only BelenceD�e s <br /> �s� •�a�' <br /> � � ��2� ' o�n���-�� ��� �v �v/� 9�a90 <br /> Owner Mailing Address City Z�n Phone <br /> ��� � <br /> ApplicaM M/ai'�ling Address City 2ip Phone <br /> Describe Proposed Work /'� ��� <br /> Project Address(if known) �-�'� r W <br /> Atlach lour(4)copies of plans for proposed work- Oraw to scale and note the lollo g as applicable: � <br /> • Property Lines • Cenlerline ol stree� � <br /> � Outline and dimensions of all ezisting and • Indicate North <br /> proposed siructures on the lot • Show any proposed grading changes <br /> • Ezisting and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMITCONDITIONS O <br /> 1.All calls lor inspection shall b�;made 24 hrs.in advance•phone 258-8810. � <br /> 2.AII work shall be peAormed in accordance with ihis permit and current City o1 Everett Design and Construction <br /> Standards and Spi�cifications. <br /> 3.Call Location Undorground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> i <br /> Pl�.l[�.G CG�C�f�i�.�i_ la�i c�� ��f � ,L�'�.�fC l."� � <br /> ��9 � <br /> � ' z.°/ '� � � <br /> r O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownei/applicant hereby agrees to hold and save harm� <br /> less ihe City of Everett from any and all claims lor damages, costs. <br /> ezpenses, or causes ol action ihat may arise because of installation <br /> and main�enance of the improvement or other rigM-of�way use hereto <br /> applied for and furlher agrees to �emOve same upon notice from ihe <br /> Approved lor Construction Date City and to replace public property damaged th=reby. <br /> FINAI INSPECTION Date <br /> Approved as �on,trucled Signature ol Applicant Date <br /> ���� PU�LICWOFKSDEPARTMENT WORIC AUTHORIZ[D BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarStree� 780 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTEF IS TO <br /> Everel6 WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPP��9E OF WORK ON 1HIS <br /> PROJ[CT OVER 90 DAVS DURATION. <br />