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Date��� � ��n����v���s Pe�mQ��.���j(j������-- <br /> Ilpplication For nmy oen� •_-U-1-i-+�i'� <br /> PUBLIC WORKS PERMIT PueTollFoeFee s <br /> Lese Apcl Fae Pe�tl s <br /> Belance Dae S <br /> Print or Type Only — <br /> �1���' �.CYI�. � � <br /> � hr�� 3ao 1 n a I���.��� �&�D I ��.-�9-�Ila <br /> Owner Mailing Addresc C t Zip Phone <br /> �"C�.� S <br /> Applicanl Mailing Address City Zip Phone <br /> Describe Proposed Work � ���" " '�'" '� <br /> W <br /> Prolect Address(il known� � <br /> Atlach four(4) copies of plans for proposed work- Draw to scale an ote the following as applicable: � <br /> • Property Lines A Centerline ol street � <br /> • Outline and dimensions of all existinEi and • Indicate North <br /> proposed structures on Ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspedion shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of [verett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•S00•42�555. � <br /> �ce� ��..k� �2���F � ��;� O <br /> �,. <br /> r �-- <br /> 7_� �: <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMGNT OF CONDITIONS <br /> The undersigned owner/appGcant her�by agrees to hold and save harm� <br /> less the City ol Everett from any and all claims lor damages, cosls. <br /> expenses, oi causes of action that may a�i�s because of installation <br /> and maintenance of the improvement or other right-of-way use herelo <br /> applied for and further agrees to remove same upon notice from the <br /> Approved lor Construction �a�e City and to replace public property damaged lhereby. <br /> �INAL INSPECTION Date <br /> pproved as ConsirucleA Signature of Applicant Date <br /> cverett PUBLIC WORKS DEPARTMENT WORK AUTHOtiIZED BY THIS PEP.".1iT tJiUST BE STARTED WITHIN <br /> 180 DAYS OF DATF ^ENMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY f-URSUED TO COMPI.ETION. THIS PEFMIT MAY BE <br /> Everett,WA 98201 CANCELI.ED dY THE CITY UPdN ANY STOPPAGE OF WORK ON THIS <br /> Phone: 253�8815 PROJECT OVER 90 Db.YS DURATION. <br />