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Date_�g$" � \ PuEI¢Wprb Parm�l• <br /> Anplication For Bipq Dept• 2� _ <br /> PUBLIC WORKS PERMIT Publ�cWarkeFee <br /> Tolal Fee S <br /> lessAOGIFeaPaiE S <br /> Print or Type Only o+�a�«o�e s <br /> /S�clo �1J�l.1 r � <br /> E�r�eN- Arat-'. DRr.1���PS /(n(Za hreu�.fl- A� �✓a�iy/ 4d� �/ aS4-�135� <br /> Owner Mailing Address Ciry Zip Phone <br /> Sa�+e <br /> Applicant Mailing Atldress City 21p Phone <br /> Uescribe Propased Work ��uey�'���'A���m�H� �/' .L �,��_y�Q� <br /> / <br /> ProjectAddress(ifknown) ��aa C ��1r�✓Q. — /Sf / �pp/� � <br /> J � <br /> Attach lour(4)copies of plans fur proposed work-Draw to scale and note the following as applicable: � <br /> • Prope�ty Lines • Centerline ol sircei � <br /> • Outline and dimensiors of all existing and • Indicale Norin <br /> proposed siruqures on the lot • Show any proposed grading changes <br /> • Existing and proposed utililies • Show measurromenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> 1.All calls lor inepection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall ba pedormed in accordence with this permit and current City of Everett Design and Constmdion <br /> Stendards and Specifications. <br /> 3.Cell LocaUon Underground Senice 4B hrs.be(ore you dig.TOLI FREE NUi.IBER 1•800-424•5555. � <br /> �/tt�.� �Jf�- ����� �I/v�'` ��,c� s=�9 6'6 O <br /> �� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ow�er/appiican�here6y agrees to hold and save harm• <br /> less the City oi Everett irom any and all claims for damage+s. costs. <br /> ezpenses, or causes oi action Ihat may arise because ol installation <br /> and maintenance ol thc improvement or olher righl•obway use hereto <br /> applied tor and luriher agrees to remove same upon notice from the <br /> App�oved for Construclion Date City and to replace pubPc property damaged thereby. <br /> FINAL INSPECT!ON Date <br /> Approved as Constructed Signature ot Applicant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTE� WITHIN <br /> � 3200CedarStreet 180 DAYS OF UATE PEFMIT IS ISSUED AND iHEREAFTER IS 1'O <br /> Everelt,WA 9820i BE DILIGENTLV PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phona:259-8B10 GANCELLED BY THE CITY UPON ANY S70PPAGE OF WORK ON THIS <br /> PROJECT:JVER 90 DAYS DURATION. <br />