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Date��V , Public WorFs Pormil• ��/�I�!�/ <br /> Ap�lication For aiec�oeo��• -�o� <br /> PUBLIC WORKS PERMIT P°°��°W°�k,F°° <br /> To„�Faa s <br /> Less��D�Fea Pei� $ <br /> Balanca Oue S �- �� <br /> Print or Type Only <br /> Q r-1- (�)n(rin. �.�n— ���-�aeE- <br /> Owner Mailing Address City Zip Phone <br /> Sa ,++.�e- <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work J�pl�1 Si �P Wl��� U� LOT �.5 l,/�Q3' �Inr,r/ <br /> �(o�B-- E/�GE�oo.�� LFJ.c/E W I, <br /> Proiect Address(if known) ��� fi���71W1�S�7t-T�— � ' <br /> Attach four(4) copies of plans for proposed work• Draw to scale and note Ihe to�lowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline anC dimensions ot all oxisting and • Indicate North , <br /> proposetl 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•881 5. � <br /> 2. All work shall be performed in accordance with this permil 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 /> O <br /> � <br /> � <br /> O <br /> a <br /> �e� ACKNOWLEDGEMENT OF CONDITIONS <br /> �W The undersigned owner/applicant hereby agrees to hold ana save harm• <br /> ' less the City of Everett trom any and all claims tor damages, cosls, <br /> expenses, or causes ot action that may arisa because of installation <br /> �� � ����� 4 B� artd maintenance ol lhe improvement or other right�ol•way use hereto <br /> � applied lor and lurther agrees to remove same upon notice trom the <br /> Approved lor Co istruction Date Ciry and to replace public properry damaged thereby. <br /> —`��( �p� �Jz' -�� (�Ff�,.�� �.KLt"ti S';f�� �/C7(� <br /> F�lf AL I�SPECTION Dale / i <br /> ,lpprovec as Construcled Signature of pplicant � Da� <br /> everett) PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everelt,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 PROJECT OVER 90 DAYS DURATION. <br />