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Date�-L�1-L)� `^ � r�ni��wo,w:a�,m��. <br /> ApplicationFor oiae.oeoi�+ �� �� '��S <br /> PUBLIC WORKS PERMIT '°°To,aFeaFea S <br /> Lesa ApyL Fee PeIE $ <br /> Palance Due $ <br /> Print or Type Only <br /> �1�1-L��1�Wf� zl,��l� C`�L�A(f�?OC�'���, �t .�G'�7�"q.��"'� �4` —c c�`7/ <br /> Owner ailing Address City Zip Phone <br /> c�ll�i�'1 F <br /> qpplicant Mailing Address City Zip Phone <br /> Describe Proposed Wcrk ���-/l)n` <br /> W <br /> Pro�ect Address(il known) H <br /> Attach four(4) copies ot plans lor proposed work- Draw to scale and note the fo�lowing as applicable: � <br /> • Property Lines . • Centerline �f slreet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing an� proposed utilities � Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shell be performed in�ccordance with this permit and current City ot Everett Design and Construction <br /> S[andards end Specificationa <br /> 3. Call Localion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> y-�.�8� O • <br /> f�v�SZic tvo,�s �,e.�.r svor .�Ec,��,eE.o y�,vz/L <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDI710NS <br /> The undersigned owner/applicant hereby 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 thal may arise because oi installation <br /> and maintenance of ihe improvement or other righFof-way use hereto i <br /> applied for and luriher agrees to remove same upon notice irom the <br /> Approved for Consiruction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> ANproved as Conslructed Signature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF OATE PERMIT IS ISSUED AND TH[REAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259-GA�7�b- BfrOC� CANCELLED BY THE CITY UPON ANY STOPPAGE OF W�RK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />