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� � <br /> �8t@.�J� � Publlc Worke Perry�t• S`���+ <br /> i S ,..s 7 <br /> 4^Plitntlon For eiao.oeo�.� <br /> RUBLIC WORKS PERi1AIT Pu�licWorknFee <br /> Tatal Fee s � <br /> Lese ApD�Fea Pa1E S_ <br /> � eaience Due S L�� <br /> Print or Type Only g�/�� <br /> \� a-� �`� - I3��, Q,� .�SC� . ��,�,-�- ����s� <br /> Owner Mailing Address City Zip Phone <br /> ��C�,�.A� _ <br /> Applicant Mailing Address City Zip Phone <br /> . � <br /> Describe Proposed Work ���� ����jz"�D <br /> W <br /> Pro�ect Address(if known) _��� — Ca/�7 .PG/� // � <br /> Attach fuur(4)copies ol ��ianr for propo=e�i work- Draw to scaie and note the lollowing as applicable: � <br /> • Propnrty Line� • Centerline of street � <br /> • Outline and dimensions ot all existing and • Indicate North <br /> proposed structures on the lut • Show any proposetl grading changes <br /> • Existin{7 and propesed utilities • Show measurements � <br /> DO NOT WRITE BELOW TF11S LINE O <br /> PERMIT CONDITIONS <br /> 7. All calls for inspection .hall be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shall be performed in acw:dar.ce with this permit and current City of Everelt Design and Construction <br /> Standards end Specifications. <br /> 3. Call Localion l'nderground S=rvice 48 hrs. belore you dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> n / ACKNOWLEDGEMENT OF CONDITIONS <br /> �/f!7 <br /> f' The undersigned own^r/applicact hereby agrees to hold and save harm- <br /> less the City of Everett irom any and all claims for damaqes, cost& <br /> ezpenses, or causes ol action Ihat may arise because of installation <br /> ` -a'/-o�'.,i_',../_- /���5 and maintenance of the improvement or other righ4obway use hereto <br /> ��' applied for and lurther agrees to remove same upon notice from the <br /> Appmved for Constr�ction � ate p��y and to replace public p operty damaged thereby. <br /> �� _,��� /i��� <br /> � INAL INSPECTION Date <br /> Approved es Constructed Siy❑ }� e of Appli ant Date <br /> PUBLIC WORKS DEPARTMENT WO�f< AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett 180 DAYS OF DA7E PERMIT I. ISSUED AND THEREAFiER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> EveretL WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT nvER 90 DAYS DURA110N. <br />