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� <br /> /� � B -337 <br /> Date PuElic Worka Parmil♦ 7 <br /> ApPlication For eioa.oeo��� <br /> PUBLIC WORKS PERMIT P��IrcWork�Fae <br /> Totel Fee s <br />� Less ApO�Fen Pa�tl $ ��� <br /> Print or Type Only Be�a��,o�> s <br /> �h��eL�U�GL���/A�rs /.�o�o �� �'�,e 5E ,E en�`19��0���7��9i <br /> Owner Mailing Address City 2ip Phone <br /> C <br /> i <br /> I <br /> ApPlicant Mailing Address City Zip Phone <br /> Describe Vroposed Work �LL1tGf <br /> .� <br /> - W <br /> Project Address(il known) S � � <br /> Attach four(4)copies ol plans lor proposed work-Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions ol all existing and � Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilitles • Show measurements � <br /> DO NOT WRITE BELOW THIS IINE <br /> PERMITCONDITIONS O � <br />� 1. All calls for inspection shall be made 24 hrs. in advance•phone 259•881 5. � , <br />� 2. All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Cal�Location Underground Service 48 hrs. betore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> Gc,o,e.e- ro �F �ui.�' .a€,P /,'.��,�o��� O <br /> �S�.�i c.5� l�6'rFF� /O-S—B> <br /> � <br /> _ _.,�, � <br /> '�,��3�si <br /> :__.� a <br /> � c, ._:.;.o�� <br /> ACKNOWLED^uEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City ol Everett Irom any and all claims for damages, costs, <br />. � expenses, or causes of aclion that may� arise because of installation <br /> ���_� B and maintenance ol the improvement or other right-ol-way use hereto <br /> Approved for Construction applied for and fu�ther agrees to ramove same upon notice Irom the <br /> ate City and to replace public property dama0ed thereby. <br /> i <br /> _�-67 <br /> FINAL INSPECTIO Dale <br /> Approved as Constructed Signature of AppGcan� Date <br /> everett PUBLIC WORKS DEPARTMEN7 WORK AUTHOHIZED BY THIS PERMI7 MUST BE STARiED WITHIN <br /> � 's20U Cedar Sireet 180 DAYS OF DATE PEFMIT IS ISSUED AND TIIEREAFTER IS TO <br /> Everelt.WA 98201 BE DILIGENiLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPIIGE OF WORK ON TH;S <br /> PROJECT OVER 90 DAYS DURATION. <br />