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r�. <br /> oate�/•1�9 r�oi��wo,ks Po,���pi.�� 2c�/z <br /> Bms.Deni.+�J-J��°�/— <br /> qpplication For <br /> PUBLIG WORKS PERMIT PublicWorksFee <br /> Totnl Fee $— <br /> Less Appl.iee Pai� S <br /> Batancc Due 5 <br /> Print or Type Only <br /> Owner Mailing Address City Zip Phone <br /> Applicant tdailin�Address City Zip Phone <br /> ia non7- I M 11rA✓AYHA[� �b/ �/'m�/ Q/��Y�d� l' //6/�S� <br /> Describe Proposed Work _� � <br /> W <br /> Project Address lit known) �n�� � �V/�/'G('� o�, !^1 � <br /> Attach tour(4)copies of plans lor proaosed work- Draw to scale and note e following as applicahle: � <br /> • Property Lines • Centerline ol sireet � <br /> A OuHine and dimensions of all existing and • Indlcale North <br /> proposed structures on the lot • Show any proposed�rading changes <br /> • Exisling and proposed utilities • Show measurements M <br /> W <br /> DO NOT WNITE BELOW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8$10. <br /> 2.All work shall be performed in accerdance with this permit and current Ciry of Everetl Design and Consiruction <br /> Standa�ds and Specifications. � <br /> ! 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. <br /> I UB�'i C(JO"�lh/..r/✓w�"� NO�/CC,�`' -�,f-``'''`L� r � �Y O <br /> � `l Cy� �� � <br /> � <br /> � <br /> a <br /> AGKNO�YLEDGEMENT OF CONDITIONS <br /> The under;igned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Evere�t irom any and all claims for damages. cost;;. <br /> exp�nses, or causes ol aclion thal may arise because of installation <br /> and maintenance of ihe improvement or other right�of•way use hereto <br /> applied for and further agrees to remove same upon notice Irom the <br /> Approved for Construclion Dale Ci�y and to replace public properry damaged ihereby. <br /> FINAL INSPECTION �a1e Date <br /> Approved as Constructed Signature of Applicant <br /> WORK A:JTHORI2ED BY THIS PER�d1T MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 180 UA'IS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Sireet BE DIL',GENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BP <br /> Everett.WA98201 CANCF:LLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PRO:ECT OVER 90 DAYS DUR�TION. <br />