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c <br /> ��� '---.... . .. <br /> CC DaiC "-�T.1-� U � ^ n��m��wo,�sre, I,^ <br /> 'pj (q � APPlication For eino onoi.• • �4�CJ�— <br /> "� �` PUBLIC WORKS PERMIT P°°��°W°«SFCe <br /> y H . toi.,i Fee `� <br /> �f] � Less nnui.Fee aaia S_ <br /> �� N Print or Type Only e�����e o�� s <br /> ��1� � �j����� � <br /> H [�s� g Owner Mailiny Atltlress City Zip Phone <br /> �r (7 <br /> H <br /> zN <br /> Applicant Mailing Address City Zip Phone <br /> f+ H <br /> Z�i w - <br /> H C�� � l- <br /> 9� y Describe Proposed Work <br /> HO � _ — — t ' ' <br /> y <br /> - � -- _.-- � I W <br /> --- ----'� � <br /> ! Pwlect Atldress(il kno�vn) <br /> t <br /> � Attach four(4)copies ol plans lor proposed work� Draw to scale and te the lollowing as a le: � <br /> • Property Lines • Centerline of street /^ <br /> • Outline and dimensions of all existing and • Indicate North V� <br /> proposed structures on the lot • Show any proFosetl gradinc� changes <br /> • Existing and proposed utililies • Show measurements �A ,. <br /> W <br /> ' '�1 ' DO NOT WRITE BELOW THIS LINE � <br /> PEP�AIT CONDITIONS <br /> ��' 1.All calls tor inspection shall be made 24 hrs.in advance�phone 259•8610. � � <br /> 2.All work shall be pedormed in accordance with ihis perrc�il and current City ot Everell Design and Construction <br /> '�� Standards and Specifications. <br /> � ' 3.Call Location Underground Service 48 hrs.tefore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> _ �� �� <br /> _ � <br /> �; �;'��� � <br /> �- s��z - a9 � <br /> � <br /> � O <br /> ►-� a <br /> �_� <br /> I�; ACKNOWLEDGEMENT OF CONDITIONS � <br /> � The undersigned owneqapplicant hereby agrees to hold and save harm� <br /> less Ihe Cily ol Everett irom any and all claims lor tlamages, costs, <br /> �--- expenses, or causes ol action Ihat may arise 6ecause of installation <br /> and maintenance of the improvemenl or other right-ol-way use hereto <br /> applied lor and luriher a9rees lo remove same upon notice trom ihe <br /> Approved lor Consiruction Date City and to replace public property damaged�hereby. <br /> FINAL INSPECTION Date • <br /> Appm�ied as Constructed SignaWre ol Applicant Date <br /> WORK AUTHORI2ED BY THIS PFRMIT MUST BE STARTED WITHIN � <br /> everetl PUBLiCWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DIL�GEN7LY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 99201 CANCELL6D BY THE CITY UPON ANV STOPPAGE OF WORK ON TH�S <br /> Phone:259�8870 PROJECT OVER 90 DAYS DURATION. <br />