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Date�, �r ' � PubliC Wo�kS Perm:t e ����� <br /> Application For eiao�oop�.s �- ,�.� <br /> PUBLIC WORKS PERMIT PubTolalFeeF°a � <br /> Losa A00�Fen Pnitl $ <br /> Belance Due S Z��'O <br /> Print or Type unly <br /> ��i' ) � _�i,J .�1C`l2 !';'{.'7 `1,P�// 1LLYd; .L�L, - ! U` ?( (� �L'�/1.'� .�r�—F��:��- <br /> 'Owner'�� Mailing A dre5k� City Zip Phone <br /> !�,'�%:')��-.� � � <br /> Applicant Mailing Address City Zip Phone <br /> Descri6e Proposed Work �r—'2 ` /� c�� � � <br /> W <br /> Project Address(il known) ZJO — C�.'ESENT Al/c�. � <br /> Attach four(4)copies of plans for proposed work• Draw to scaie and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline end dimensions of all existing and • Indicate North <br /> proposed structures on the�ot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIO'v5 <br /> - 1. All calls for inspection shall be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shall be aerformed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Undergiound Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424-5555. � � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � l��w` The undersigned r-.vner/applicant hereby agrees to hold and save harm- <br /> less the City of Everelt trom any and all ciaims for damages, costs, <br /> expenses, or causes of aclion that may arise because ot installation <br /> . ryy � _� 87 and maintenance of the improvement or other right•ol-way use hereto <br /> Approved for Con tr ion Date applied for and lurther agrees to remove same upon notice from the <br /> Ciry and to repiace public p "perty damaged lhereby. <br /> !�� �ol 1�rflc �� � � J `� '"") <br /> FINA INSPECTION D e ��%:�" ' [�`��- b —�S V / <br /> Approved as�onsiructed Sig ture of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERM�T MUST BE STARTED WITHIN <br /> � 3200 Cedar Slreet tE� DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,W:1 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />