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� •, <br /> Da�e "' Public Works Permit r l �� <br />� BICp.pept.r <br /> ApplicatioR,For <br /> PUBLIC WORF�S PERMIT PublicWo�knFaB � <br /> To�al Fee S <br /> �.� Less AoO�Fea PeiO � 1J�7 .a� <br /> U ��/ � <br /> L� Balanca�ue S <br /> I Print or Type Only � �`�-�' j'n pncTl��(; a-a5'G3 <br />� m �- N <br /> I � � ` " <br /> �.� .� <br />�� �/ M tl. <br /> rSEcy��,r .s�eL�� / �l�. /� �'7�7 Gi� �f37��ti Z.�-'i�3S� <br /> Owner � Maili �AtJtl(es6: ;, CitY � Zip Phone <br /> , ��y��o y-� Cl�7vr-�� <br /> �� cft %(r+nZ�7�'���'z',�/fr'��, `y��d/ L5�1-3/�/ "` `'n- <br /> _ Applicant Mailing Address City Lp Phone <br /> ; Describe Proposed Work �r�/��� ' "' `^'� /�n� <br /> � <br /> Proiect Address(if known) l � <br /> Attach four(4)copies of pians lor proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street ♦A <br /> • Outline and dimensions of all ezisti�g and • Indicate North V� <br /> proposed 5tructures on the 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 lor inspection shall be made 24 hrs.in advance•phone 259•8810. � � <br /> 2.All work shall be performed in accordence with this perrr�it and current City of Everett Design and Construction <br /> Standards and Specifir.ations. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> `'�' ��' %o/�'°�� �/L �i�e� /o -/�' • 9/ O <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONOITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City ol Everelt Irom any and all claims for damages, costs, <br /> ' expenses, or causes f-action that may arise because of instal�ation <br /> // _� and maintenance the improvement or other right-ol-way use hereto <br /> ` � y� applied for an �fier agrees to remove same upon notice irom the <br /> Approv for Constru n �� a City and pl C pu per y damaged thereby. <br /> ��� �. <br /> � LG ! `;f O B c. <br /> FINAL INSPECTION Date <br /> Approved as Conslructed Signalure ol Applicant Date <br /> WORK AUTNORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> PUBLICWORKSDEPARTMENT 180 DAY3 OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PEHMIT MAY BE <br /> Everet6 WA 98201 CANCELLED 8Y THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />