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DateJ[.l—1✓ Public KbrMs Permp s � _ <br /> Blag.DaV��� ��� " / <br /> � Application For <br /> PUBLIC WORKS PERMIT Pu�licWorMnFee — <br /> Totai Fee s— <br /> Leea AOP�.Fee Peid S — <br /> Beiance Due S <br /> Print or Type Only — <br /> �o.shi�. a �C1�2Sc` V�1Gr�en I,�J✓ �v��tf 9�"?��� 7�/.�=_32/� _ <br /> Owner Mai4in� Cit� �p Fhone <br /> �7�3- /�S5 <br /> Applicant Mailing Address Cdy LP Phone <br /> Describe Proposed Work --�f�aLY6d�[�-� Y i��-��l.W//Gf � �il Ltit .�( .��� <br /> � <br /> W <br /> , �Project Address(if known) <br /> Attach four(4) copies of plans for proposed work• Draw to scale and note th ollowing as applicable: � � <br /> • Property Lines • Cenlerline of street � : <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structu�es on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuraments M <br /> W <br /> ' DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls tor inspeclion shall be made 24 hrs.in advance•phone 259•8$1 O. � : <br /> 2.All work shall be peAormed in accordance with this permit and current City of Everett Deslgn and Construction <br /> Standards and Specifications. . <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOL�FREE NUMBER 1•800-424-5555. � � <br /> O <br /> PUBLIC WORKS PERMIT � ' <br /> NOT REQUIRED <br /> BY�. .� . - � � <br /> DATE_ /O-e'�7-`�9� � <br /> � <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agree�to hold and save harm- <br /> — less ihe City of Everett irom any and all cltims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance of the improvement or other right-of•way use hereto <br /> — applied for and further agrees to remove same upon notice from lhe <br /> Approved for Construction Date City and to replace public properry damaged thereby. <br /> FINAL INSPECTION Date Dale <br /> Approved as Constructed Signature of Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> ���� PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS �TO <br /> 3200CedarStreet BE DILIGEN7LY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98207 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS ` <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />