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.�J- Q-� �. . .\ . <br /> Date �. - Publlc Works Permil r <br /> Application For Bidg.�epl.• Q <br /> PUBLIC WORKS PERMIT Pu�7otalFeeFee $ <br /> Less Appt Fee Paitl $ <br /> 9alanco Dua $ <br /> Print or Type Unly <br /> ��.f-�a�o <br /> <��a►���nnn� i 1;��r�� As�.^�^ . � i � n i�� ,�r� tit�. ���n �� fr-�v���. q��� <br /> Owner � Mailmg Address City 2ip Phona <br /> ��-i 1'''t'��' l�c I I �F���iU"\f,lE�, (,U C'�=/��L'! ��� '��L�� <br /> Applicant �� Mailing Address City � Zip Phone <br /> Describe Proposed Work �c_L�Y'�'�� •�� LT"�'�n��m�^�� .- <br /> 1d - W <br /> Project Address(if known) � / ^� �` � <br /> Attar,h four(4)copies of plans for proposed work• Draw to scale and note the following as applicable: � <br /> ! Properry Lines • Centerline of street ♦A <br /> • Outline and dimensions ot all exisling and • Indicale North Vd <br /> proposed siructures on lhe�ot • Show any proposed grading changes <br /> • Existing and proposed ulilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance• phone 259-881 5. � <br /> 2. All work shall be per(ormsd in accordance with this permit and current City of Everett Design and Construclion <br /> Standards and Specifications. <br /> 3. Call Location Underc�round Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424-555�. � <br /> �'� % � <br /> � d ;�� � <br /> + J ' , V� <br /> / � � <br /> ��� �. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe City of Everett from any and all claims tor damages, cosis, <br /> expenses, ar causes of action that may arise because of installation <br /> and maintenance of the improvement or other right-of-way use hereto <br /> applied for and (urther agrees to remove same upon notice trom the <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Consiructed SignaWre of Applicant � Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS �SSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />