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_ _ _. . . __ _ <: . .�,..r:,�r= <br /> ^� / n � <br /> �8te v 1'O�l I�v . • PuClic Wods?nrm11• <br /> �_ '��' �07 as� <br /> Application For <br /> emg.o«ai.: <br /> PUBLIC WORKS PERMIT PubTolalFeaFee S <br /> �ess ADG�.Fee Paid S <br /> Balance0ue S <br /> Print or Type Only <br /> � ('� r r �- [ NG� �`r3`.=�YoLe <br /> Owner MaiNng Address City Zip Phone <br /> ��7r � M� �S �w �AL �cS� `�9riCJ <br /> Applicant Mailing Address City ZiP Phone <br /> —f/- �� ,�) /� <br /> Describe Proposed Work ��}1�J '��.�{�� r� ��{��'� {Z <br /> W <br /> ; i , - � � � <br /> Prolect Address(if known) <br /> Atlach four(4)copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposad 9rading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONOITIONS <br /> 1.All calls for Inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work ahall be pertormed in accordance with this permit and current City of Everett Design and Construction <br /> Standerds and Spacifications. <br /> 3.Cell Locatlon Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800�424-5555. � <br /> �U�+l�oe Gt/au�:. f�_eiu.:;-f /1/��,��r,ti.0�n O <br /> , , � <br /> q`=�°:/'�°��` � <br /> � -�r -��� O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The und=rsigned owner/applicant hereby agrees lo hold and save harm• <br /> less the City of Everett from any and al! claims for damages, costs. <br /> expenses. or causes of action that may arise because of instatlation <br /> and maintenance of the improvement or other right-of•way use hereto <br /> applied for and furfher agrees to remove same upon notice irom the <br /> Approved for Construction �a�e City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � � 3200CedarStreel . BE DILIGENTLY PUfiSUED 70 COMPLETION. THIS PERMIT MAV BE <br /> Everett WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WONK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br /> 1 <br />