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Date�v v ( �, I Pu01¢Work�Pe�mh <br /> Application For emo oeo�.e c� _ <br />� Pi1BLIC WORKS PERMlT P�°T�°�;F� , - <br /> Les�Appl iee Pe�a S <br /> Print or Type Only e.�e���n�� s <br /> ��"�'�'�'� �'�t 1�L;�'�i"I 1 <br /> wner aihng ress City Zip Phore <br /> Applicant Mailing Atltlress City Zip Phone <br /> Describe Proposed Work T�rn��t �y1 l I-J � <br /> Project Adtlress�il known) � ��'� ��.( �l � � <br /> Attach low(4)copies oi plans br proposed work- Draw tn scale and note ihe foll�pplicable: � <br /> • Property Lines • Cenlerline ol sL•eet � <br /> • Outline and tlimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • E�isting antl proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONCITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pertormed in accortlance with this permit and current City ol Everett Design and Construction <br /> Standards and Sp=cilications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•B00-424•5555. � <br /> ,'lV� � /Z -%SL-gB' O <br /> � � l/.3� <br /> � <br /> � <br /> O <br /> a <br /> �CKNOWLEDGEMENT OF CONDITIONS <br /> The undersiyned owneUapplicant hereby agrees to hold and save harm� <br /> less Ihe City of Everelt irom any and all claims for damages, costs. <br /> expenses, or causes of action ihat may arise because ol inslallation <br /> ard ria�ntenance of Ihe improvement or other nghl-obway use hereto <br /> Approved for Conshudion applied lor and furtlier agrees to remove same upon notice irom ihe <br /> Date City and to reptace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approvetl as Conslructed Signature oi Applicant Date <br /> everett PUBLICVIORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITNIY <br /> � 3200GederStreet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> EveretLWA9B201 OE DILIGENTLV PURSU[D TO COMPLL710N. THIS PERMIT MAV 8E <br /> Phone.259�8810 CANCCLLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS UURATION. <br />