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i <br /> i <br /> i <br /> Datelt�`� �� Puahc WorMa Parmll `� �� ��/ <br /> Application For eiee.oep�.+ <br /> PUBLIC WORKS PERMIT Pu�iic�YarksFeo — <br /> To���Faa s <br /> �ess AOD�Fee Paltl S <br /> 6nlanceOuo a 20�— <br /> Print or Type Only <br /> i a'��i� � '(�a�`� 5��C� l�(.v"�J�l� ��.Y;� y8a��� �-l7(�4�5' <br /> Owner Maifing Address City Zip Phone <br /> ��i7 I lS�— <br /> � Applicam Mailing Address Ciry Zip Phone <br /> Describe Proposed Work �� <br /> � -Q�/ W <br /> ' Prole��Address(if knowo) /��� �^'�� �'��• � <br /> Attach four(4�copies of plans for proposed work• Draw to sc21e and note the following as applicable: � <br /> • Property Lines • Centerline ot street � �. <br /> • Outline and dimensions ol all existing and • Indicate North , <br /> proposed stru�tures on the lot • Show any proposed grading changes � <br /> • Existing and proposed utilities • Shcw measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMITCONDITIONS O i <br /> � 1.All cells for inspection shall be made 24 hrs.in advance-phone 259-881 O. � <br /> ' 2.All work shall be Rerformed in accordance with Ihis permit and current Cily of Everett Design and Construclion � I <br /> Standards and Specifications. � <br /> .- 3.Call Location U�derground Service 48 hrs.6efore you dig.TOLL FREE NUMBER 1•800•424•5555. � I <br /> O I <br /> � <br /> � <br /> O ' <br /> a <br /> � ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersic�ned owner/applicant hereby agrees to hold and save harm� <br /> less the Cily ol Everett Irom any and all claims lor damages, cosls. <br /> expenses, or causes o� action that may arise because of inslallation <br /> /,`/�, // /��-}� nnd maintenance of the improvemenl or other nghDobway use hereto <br /> ����'�'u � � applied for and further agrees to remove same upon notice Irom ihe <br /> Approved lor Conslru iuc-� Date Ciry and to rePlace Public ProPerty damaged thereby. <br /> lvl �— 3—�� � , <br /> FINAL INSPECTION Date �Z—y�— &� <br /> Approved as Construcled Signalu�e of Applicant Date <br /> WORK AUTIiORIZED BY THIS PERMIT MUST BE STARTED WITIiIN <br /> evcrett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERM�T IS ISSUL'D AND THEREAFTER IS TO <br /> � 3200CedarStreet BE D�LIGENTLY FURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Evarett.WA 9820� CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 pROJECT OVER 90 DAYS DURATION. <br /> � <br /> I <br />