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�s�� ,� ,- <br /> 'Date P���,<<�+o�ks P���.��. <br /> App'ication For ema oec+.• - <br /> PUBLIC WORKa PERMIT PubTo�eFeeFpE S <br /> Lesn AOP�Fee PaN S <br /> Bslance Ove $ <br /> Print or Type Only <br /> � ����0� Mailinp Address City Zip Phone <br /> Applicant Mailing Adtlress Cdy Z�p Phonc <br /> Descnne Proposed Work 1 —�� — — <br /> - W <br /> Project Address(if known) <br /> .�.� aa �.. <br /> Atlach lour(4)copies ol plans for proposed work- Draw to scale and note the followinc�as applicable: � <br /> Y Propi•rty L�nes • Centerline ol streel � <br /> • Outnr�c anc dimensions ol all exislin9 antl • Indicate North <br /> proposad stru�tures on the lot • Show any proposed grading chanc�es <br /> • Ezisting and proposecl utllilies • Show measivemenis � <br /> � DO NOT WRITE BELOW THIS LINE O <br /> PEfiM1T CONDITIONS <br /> 1.All calls for inspectien shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be performed in accordance with ihis permit end current City of Everett De:,ign and Constmction <br /> Stardards and Specifications. <br /> 3.Call Location Underground Service 48 hrs belore you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> r�ot ��a. 0 <br /> �� H <br /> � ,� �s � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersi8ned owneVapplicant hereby agrees to hold and save harm- <br /> less Ihe City of Everelt Irom any and all claims lor damages, co>Is. <br /> expenses, or causes oi action that may arise bewuse ol installa•.ion <br /> and maintenance oi the improvement or other nght-obway use he�eto <br /> applied lor and luriher aprees to remove same upon notir.e Irom uie <br /> AnProved for Construdion Date City and to replace public properry damaged Ihereby. <br /> FINAL INSPECTION Date <br /> ApUmved as Gonstructed Si�nature ol Applicant Uate <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED N^.THiN <br /> � 3200CederSlreet 180 DAYS OF DATF PERMIT IS ISSUED AND THEREAFT_R IS TO <br /> Everelt.WA 98201 BE DILIGENTLY PUASUED TO COMPLETION.THIS PERMIT MAV BE <br /> Phonr.259�8810 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WCRY.ON THIS <br /> PROJECT OVER 90 OAYS DURATIUN. <br />