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Date 3—� 'g� Pohi¢WoihsPcrmn• <br /> Application For eing o�pi . <br /> PUBLlC WORKS PERMIT PUbTotalFeeFeo $ <br /> Less Appl Fee Paid S <br /> Oalance Due .� <br /> Print or Type Onty <br /> l7ale_. Pe�,.'t� ��� le+-Lr�� Lh. Euc�e�t" 98io3 3�E�S-3-a5'£� <br /> Owner Mailing Addr s City Zip phone <br /> SaN�e/ <br /> Appiicant Mailing Address City Zip Phone <br /> Describe Proposed Work `�X�a'^� ��u�-- �� • <br /> Projed Address(il known) aj'`'w� �V�� ��'�/��5 '� �„ � <br /> � <br /> Attach four(4)copies oi plans for proposed work- Draw to scale and nole the following as applicable: � <br /> • Property Lines • Centedine ol street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities � Show measuremenls � <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•8810. � <br /> 2.All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> ��� � <br /> ��f � � <br /> � ti <br /> � f �.e�,w� �c� V� <br /> 0 0 <br /> a <br /> n� ACKNON'LEDGEMENT OF CONDITIONS <br /> �� The undersic�ned owner/applicant hereby agrees lo hold and save harm- <br /> less the City ot Everett Irom any and all claims lor damages, costs. <br /> expenses, or causes of aclion that may arise because of installation <br /> and maintenance ot the improvement or other right•of�way use hereto <br /> applied for and lurther agrees to remove same upon notice Irom the <br /> Approved for Consiruction Date City and to replace publ�c property damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Consiructed Signature ol Applicant Date <br /> everett PUBLIC WORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarSlreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-BB70 PROJECT OVER 90 DAYS DURATION. <br />