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_ i <br /> oatel'�.��c6 ;�1°°J �� 'j PuO�mWo�ksPer �. , <br /> AppliCation For einp Deo�.+ i �y�Q�__ �i <br /> PUBLIC WORKS PEFiMIT P°�����w�«SFCe --- <br /> TotalFee $ — <br /> �P55�1p01.FAP Pd�d � _ <br /> Print or Type Only Balance�uc � <br /> �� ��'1'�i��rl �]l��'�� �In� AV�' �' l�i ,t?�� _L5 . <br /> Ow� MaiHng Address Ci�y Zip Phone <br /> �A-Il'� �NTi2V �,��fYl �'_l ) �IUD�1,� ��JUn �� �'?�r�- i _ <br /> . Applir,ant Mailing Address City Lp Phone I <br /> � Describe Proposed Work �Il ,t !—I��� d�l� X iC I <br /> � I, <br /> Project Address(il known) � � <br /> Attach four(4) copies of plans(or proposed work- Draw to scale and nole the lollowing as applicable: � ' <br /> �� • Properry Lines • Centerline of�ireet � <br /> � • Outline and dimensions ol all ezisting and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � � <br /> � DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> . 1.All calls for inspection shall be made 24 hrs.In advance•phone 259-881 O. � <br /> . 2.All work shall be pertormed in accordance with this permit and current City ol Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � � <br /> �� �' �' I fZ�D O !i <br /> ��� � <br /> /�-� -aa � <br /> O <br /> a <br /> ; . <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and sava harm� <br /> � less the City of Everetl Irom any and all claims for damages, costs. <br /> � expenses, or causes of action Ihat may arise because ot installation <br /> and maintenanco of Ihe improvemenl or other right-ot-way use hereto <br /> applieA tor and further ac�rees to remove same upon notice Irom the <br /> Approved lor Construction Date C�t/and to replace public property damaged thereby. <br /> FINAL INSPECTION Oate <br /> Approved as Constructed Signalure ol Applicanl Dale <br /> everett PUBLIC WORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTEU WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 70 <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8010 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. I <br /> I <br /> I <br />