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Date�=g� P�e�,��vo�k�a�,m��. <br /> � <br /> Application For eiaa.o�nc.�_ � <br /> PUBLIC WORKS PERMIT PuElicWork9Fee <br /> Talnl Fee $ <br /> Less Appl Fee Pa1C $ <br /> Print or Type Only e��a��a o�a s <br /> c.���� � �� ����1�,��a? �2c�, ��� �ao� �a-3.� <br /> Owner �Mailing Address City 2ip phone <br /> �'��'lA <br /> � <br /> Applicant Mailing Address City 2ip Phone <br /> i �/��� <br /> Cescribe Proposed Work �1G1 <br /> Project Address(if known� �"7i1��� C '�l_��{-�—��vl���� �' JfC � <br /> Attach four(4)copies of plans for proposr.d work- Draw to scale and note the following as applicable; � <br /> • Pronerty Lines • Centerline ol street � <br /> i Outline and dimensions ol all existing and • Indicate North <br /> proposed siructures on the Ic� • Show any proposed grading changes <br /> • Existing and proposed utililie; • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for(nspeclion shall be made 24 hrs. in advance•phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Ever=tl Design and Construction <br /> Standards and Specilications. <br /> 3. Call location Ur,derground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> PI��G I G Gt�a,e,�S f�c/��iT it/Ur ��-cy�ii,e�o 8.Z7-8 7 O <br /> ��� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the City of Everett from any and all claims lor damages, costs, <br /> expenses, or causes of action that may arise because ol inslallation <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 ihe <br /> Approved tor Construction Dale <br /> City and to replace public property damaged Ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHOAIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Slreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS 70 <br /> Everett.WA 98201 BE DIIIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />