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-- - - <br /> IDate�Z � � Publ¢Warka Pcrmlt• _ <br /> � Application For Blap Depl.• <br /> � PUBLIC WORKS PERMIT P��TalaFceF�� : <br /> Less ApPL Fee Paitl $ <br /> Print or Type Only ea�a��ao�a s <br /> �O�L <br /> Owner Mailing Address City Zip Phone <br /> I <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work �C-\�/ C:�t/-�`�- i�--�tr <br /> W <br /> Prolect Address(il known) �—" �+'�l ���1r`1���--���"' � <br /> Attach four(4)copies uf plans for proposed work- Draw to scale and note the lollowing as applicable: � <br /> • Prope-ty Lines • Centerline of street � <br /> • Outline and Jimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LIN O <br /> PERMIT CONDITIONS <br /> 1.All calls tor inspection shali be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Consiruction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> `_�y�/ N GT �E-C� � <br /> f�u� Yti` ` t=B.st. � <br /> Jc� - � L - 90 (� <br /> 0 <br /> a <br /> PCKNOWLEDGEMENT O�COI�DITIONS <br /> The undersigned owner/applicant hereby ag:ees to hold ai�d save harm- <br /> less the City of Everett Irom any and all claims for damages, costs. <br /> expenses, or causes ol action Ihat may arise because of inslallation <br /> and maintenance ol the improvement or other righl-ol•way use hereto <br /> applied for and lunlier agrees lo remove same upon notice Irom the <br /> Approved lor Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Construc�ed Si9na�ure ot Applicant Date <br /> everett PUBLIC WORKS D[PARTMENT �^10RK AUTHORIZED BY 7HIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BE DILIGENTLY PURSUED TO COMPLETION. 7FIIS PERMIT MAV BE <br /> Phone:259�8810 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />