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�/ /� rn P�STI NG�.Q r -,�. --______ _--- _ � <br /> �8t6�/ � / % Pu�lic Works Permit x � L <br /> Application FOr � ema.oeo�.r <br /> PUBLIC WORKS P�MIT PublicWorkeFae <br /> To�.�Fea s <br /> � � � O �ee9 AD01.Fae Paid $�/�/� L <br /> Balence Due s "f'�/V <br /> Print or Type Only o � � G <br /> s '" .Maw <br /> � <br /> ���, ,�.����1 4��/ -�.��J �,�A�-� ���z��!���r�� <br /> Owner Mai4ing Address \ �� c�i y� Zip Fhone <br /> � � � � O <br /> A pl cant Mailing Address City ip Phone <br /> Descri Proposed Work <br /> � � � <br /> � � � �� W <br /> , <br /> P�oject Address(if known) , � <br /> Attach four(4)copies of plans for propo ed work- Draw tc sc ,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 proposed gr2ding changes _ <br /> • Existing and proposed utilities • Show measurements � <br /> �� DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> . 1.All calls`or inspection shall be made 24 hrs.in advence-phone 259•8810. � <br /> 2.All work shall be periormed in accordance with this permit and current City of Everett Design and Construction <br /> � Stan�ardsandSpecifications. <br /> , 3.Cell Locatlon Underground Service 48 hrs.befora you dig.TOLL FAEE NUMBER 1•800-424$555. � <br /> �. 1�..�i►- vp�o,�^--�� p�c�— c���c � 3�/-9 yc 0 <br /> /0 / <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant heieby agrees to hold and save harm- <br /> - - less the City of Everett from any and all claims 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 /> �— app6ed for a urther agrees to remove same upon notice from the <br /> Ap rov Co1� ructi . ate Ciry and repl e public property damaged thereby. <br /> / <br /> /D <br /> �"IN 10 ete � <br /> s�pproved as Constructed gn t e Applicant Date <br /> PUBLIC WORKS DEPARTMENT WORK THORIZED BY THIS PERMI UST BE STARTED WITHIN <br /> 3^c00CederStreet 780 D S OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt,WA98201 BE D IGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> �� Phone:259-8810 CA ELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> \ PR JECT OVER 90 DAYS DURATION. <br />