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� <br /> i <br /> ' ( <br /> Date�.�rny Pu�Lc Wo•ks Permil• <br /> � i BICp.DeOt• g 7��� � <br /> Application For <br /> PUBLIC WORKS PERMIT °°°4o,:FeaFeB s <br /> Leea Rppl Poe Pei� S <br /> Belance Dua S <br /> Print or Type Only <br /> 7 _ -Y � <br /> _1�,,,1,�F ,v,llin�r I �Z�7 ��(�� c� F✓eirtf' �i�Zo �/ 33) �f �i <br /> Owner Mailing Address y Phone '�I <br /> Co-P.! Fi�tGp-�v-��� � <br /> Applicanf Mailing Address City Zip Phonc <br /> Describe Proposed Work � ���n � '�(� `�- � m��"—�`����n // <br /> - W <br />� Pro�ect Address(if known) � <br /> Attach four(4)copies ot plans for proposed work• Draw to sc21e and note lhe lollowing as applicable: � � <br /> � Property Lines � Centerline of streel � I <br /> • putline and dimensions of all exisling and • Indicate North <br /> proposed structures on the lot • Show any pr�posed grading changes <br /> • Existing and proposeC utililies • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O ' <br /> PERMIT CONDITIONS <br /> 1. All calls tor inspection shall be made 24 hrs. In advance-phone 259•881 5. � � <br /> 2. All work shell be perlormed in accordance with this permit and current City o1 Everett Design and Conslruction <br /> Standards and Specifications. I <br /> 3. Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> /LiO'ciC �ri�yC23 1��=�'/,n�%/�v� ���U�.c-_;E,G' �.3� 7 O <br /> . � <br /> � J � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and 5ave harm- <br /> less the City o� Everett irom any and all cleims for damages, costs, <br /> expenses, or causes of action that may arise hecause ol inxtallation <br /> and maintenance ol ihe improvement or other righFof-way use hereto <br /> epplied for and further agrees to remove same upoi notic2 irom the <br /> Approved lor Construction Dale Ciry and to replace pubCc properry damaged there6y. <br /> FINAL INSPECTION Date Date <br /> Approved as Constructed Signature ol Applicant <br /> WORK AUTHORi2ED BY THIS PERMIT MUST BE SIARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 7g0 UAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br /> � 3200 Cedar Street BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 9820i CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259•8875 PROJECT OVER 90 DAYS DURATION. <br />