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Daie_._L ,�, � <br /> PubLc Wo�ks Permil a _� <br /> AppliCdtlOn Fof Bitle�Oe�l..�) k, <br /> PUBLIC WORKS P�RMIT Pu�To�alFaeFeo $ � <br /> Less ApP�Fea PaiO S <br /> Print or Type Only n��a��,o�o a <br /> ��-I'�t2�?I'1C(1'l��',� . ��1'� I�S�� �(-�� �1 '� ('��(LF��I( � ���x/ ��'��-���'l� <br /> Owner Maihny Addre:,s Ciq• Zip Phone <br /> � ' � �; �r �a�r,l i��4 i ��1�an�� �nr��� �s� �- ���� <br /> Applicant Mslling Address Cdy Zip Phone <br /> Doscribe Proposed Work. �,�� _ �1�11�� �c+ 't ����C� �.F—f�. � <br /> Proiect Address(il krowN _ "�1`}��7 � �.� �-�f�.:{ �i( � �,(_X{,\ � � <br /> Attech four(A)copies of plans for proposed work- Draw to scale and note the following as appiicable: � <br /> • Property Lines , • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate Norih <br /> proposed structures on the lot • Sbow any proposed grading changes <br /> � Existing and proposed utilities • Shcw measurements � <br /> DO NOT WRIiE BELOW THIS IINE <br /> PERAfIT CONDITIONS O <br /> 1. All calls;or inspection shall be made 24 hre. in advr r •phone 259•881 5. � <br /> 2. All work shall be performed in accordance viith thls permit and current Cily of Everett Design and Construction <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800•424•5S5S. � <br /> � <br /> �L�L �1� �(_! �`., ����1�I 11 'l�- �'1i_�� �E�C:�Y. 7�(�"� � <br /> ;�� � <br /> ` � � <br /> 7-i;-��; <br /> � <br /> � <br /> ' 1 P.CKNOWLEDGEMENTOFCONDITIONS <br /> . The undersigned owner/applicant hereby agrees to ho�d anG save harm- <br /> less lhe City o( Everett from any and all clafns for damages, costs, <br /> expenses, or causes of action that may arise because o( installation <br /> and maintenance of the improvement or other ri�ht•of-way use hereto I <br /> oved fnr Construction Date applied far and (urther agroes to remove same upon notice from the <br /> City and to replar,e public property damagad Ihereby. I <br /> � INSPECTION Date <br /> � , ved as Constructed Signature of Applicant Date <br /> rett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY 1"HIS PERD4IT MUST BE STAR7ED WITHIN <br /> 3700CedarStreet 180 DAYS OF D.4TE PERMIT IS ISSUEC AND THEREAFTER IS TO <br /> - Everett, WA 96207 BE DILIGENTLY PURSUED TO COMPLE'iiON. THIS PERMIT MAY BE <br /> �� � Phone: 259•8815 CANCELLED BY THE CITY UPON AN1'STOPPAGE OF WORK ON THIS <br /> : PROJECT OVER 90 DAYS DU'tATION. <br />