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- ,- <br /> Date � '� Pubhc WorMs Permi�a �� <br /> Application For eias.oer,�.. <br /> PUBLIC WORKS PERMIT P°°��°W°�k°F°e ' <br /> Total Fee s I <br /> i <br /> Less Appl 7ee Paitl s � <br /> Pfint Of Type Gnly ea�a��a o�e S I <br /> i <br /> � <br /> �.:i�s�l pn��.� 48c�a �5� '�r;�e ��e�� Q9ao3 aS9 -70`d3 ; <br /> � <br /> Owner Mai4ing Address Ciry Zip � Pnone I <br /> w��/ <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work �-.n sa• -�'f'• nlini�w r���,�, na�d.�1'ien � �,�.4�t{� �, .q�_ <br /> � l/ <br /> �d�( t.�,.d��.�s <br /> /v W <br /> Project Address(if known) ✓ � ' <br /> Attech 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 N i <br /> proposed structures on the lot • Show any proposed grading changes i <br /> • Ezisting and proposed utilities • Show measurements � ; <br /> DO NOT WRITE BELOW 7HIS LINE O I <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be mede 24 hrs.in advance-phone 259-8810. � ', <br /> 2.All wotic ahall be peAormed in accordance with this permit and current City of Ev,rett Design and Construction <br /> Standerds and Specifications. <br /> 3.Call Location Underground Service 48 hrs.befoie you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �U.G�c�L ,�f �� ,e�. � <br /> �-�7-�8 I-- <br /> �'�. N <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City ot Evered from any and all claims foi 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 �urther agrees to remove same upon notice from the <br /> Approvad for Coiistruction Date City and to replace public property damac�ed thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200Ceda�Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BF DILIGENTLY PURSU[D TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259•8870 CANCELLED BY THE CITY UPON APJY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />