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Date���� � ` D <br /> Public works Permit r <br /> Application For Blag.Dept.r <br /> PUBLI� WORKS PERMIT PuoTotalFeeFee $ <br /> �ss Appl.Fae PaiO S <br /> Print or Type Only /C Bnlan�o Duo S_ ��g�� <br /> �'g2�� <br /> � 45 A4�c�c. r ..cd S���rc � � R �.vG C'• ] . PA• U � Fi�tG �1�t�.2�r. t,iA� <br /> Owner Mailin�Address Cit <br /> /+ Y Z�P Phone <br /> v�' 1`)'L= <br /> Applicant Mailing Address Cit <br /> /� Y Z�P Phone <br /> P —a1rJt 1/��� � / <br /> De&cribe Pro osed Work ' i ���•�p�7-�- /��L /Jr � <br /> ��� a Tr <br /> Project Address(if known) � � � <br /> Atfach four(4)copies of plans lor propose work• Drav.�to scale and note the following as ap ' able: � <br /> • Property Lines � <br /> • Outline and dimensions of all existin and � Centerline of street I_ <br /> 9 • Indicale North v� <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and propused utilities • Show measurements <br /> DO NOT V✓RITE BELOW THIS LINE � <br /> PERMIT CONDITIUNS � <br /> 7. All calls for inspection shall be made 24 hrs. in advance• phone 259•881 5. <br /> 2. All work shall be performed in accordance with this permit and curreni Ciry of Everett Design and Construction � <br /> Standards and Specification,. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•804-424-5555. <br /> �l • ��!/r QF�rl�Fd /���nS Z <br /> � � <br /> � <br /> Y✓ <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CJNDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and savA harm- <br /> '- less the Ciry ol Everett irom any and all clo.ms for damages, costs, <br /> / —�� expenses, or causes of ac�ion �hal may arise because of ins(allation <br /> � �� and maintenance of ihe improvement or other righbohway usr he�eto <br /> rove or ns�r Tion D2te applied (or and iurther agrees to �emove same upon notice from the <br /> _ / �� � City and to replace public propert� imaged thereby. <br /> fINALIRSPECTION �' <br /> Approved as Constructea Date Si9^�ure of Appli�—� �/'�/� r <br /> Da[e <br /> evere[t PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 CedarStreet 180 DAYS OF DATE PERAIIT IS ISSUED AND THEREAFTER IS TO <br /> EveretL Wq 96201 BE DILIGENTLY PURSUED TO COMPLETIOIJ. THIS PERMIT MAY BE <br /> Phone: 259-8d15 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />