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Date�� v„�.��wo,��r�•����. <br /> Application For oma.oeo�..� <br /> PlJBLIC WO}�KS PERMIT PublitWo�ksFeo — <br /> .o�a�F�a s <br /> LessAppl fecPaid $ <br /> Print or Type Onry �,,�,�-�•n�� s _ <br /> 7,-h., /�1�ri�', 790/ /,�l, C l�„ /). F �� 9,�zr �� 3S 3 -y� z 6 <br /> Owner Maiiinq Address Cily Zip Phone <br /> Ne�la ndQ� �o,,cJ f a 5 - // "'/�,e fi �,a rv f.f ���8- 3S 3-Ssc / <br /> ApF'icant Mail�ng Address City Zip Phone <br /> Describe Propused Work �p4��� -�. �t�/� <br /> W <br /> Project Address(if known) .� � <br /> Attach four(4) copies ol plans for proposed work• Draw to scale and note ihe following as applicable: � <br /> • Property Lines • Cenlerline of street � <br /> • Outline and dimensions ot all existing and • Indicate North <br /> proposed structures on the lot • Show any propoaed grading chan�es <br /> • Existinc� and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THI� '_INE O <br /> PERMI?CONDITIONS <br /> 7. All calls for inspection shall be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shall be performed in accordance with thia permit and current City of Everett Desi�n and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUII7BER 1•800•424•5555. � <br /> � 7'""//BGiC L�IU/'.FS �%PmiT /�T ���4v���°60, �D-Cb'�b'� O <br /> ��� � <br /> � <br /> 0 <br /> a <br /> ACKNO'NLEDGEMENT 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 for dam2ges, costs, <br /> expenses, or causes ol action ihat may arise because of installation <br /> and maiNenance of the improvement or olher right�ohway use nereto <br /> applicd for and further agrees to remove same upon notice Irum ihe <br /> Approved lor Construdion ���' Ciry and to replice puUlic propmty damaged thereBy. <br /> FINAL INSPECTION Date <br /> Approved as Construcled Signature ol ApPiicant Date <br /> everett PUBUC WORKS DEPARTMENT WORK AUTHOFIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSL AND THEREAFiEH IS TO <br /> Everelt,bVA 98201 BE DILIGENTLY PURSUED TO COMPL_�ION. THIS PERMIT A1AY BE <br /> Phone: 259�8875 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOFK ON THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />