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,ate�/ �-v Fu�lic Worka Par 1• �" _ �`'� <br /> I <br /> Application For eiae�oea�.._ <br /> PUBLIC WORKS PERMIT P°°��°W°�k,F°e <br /> Tolel Feo s <br /> lesa AOG�Fee Pai� S <br /> Print cr Type Only ea�a��ao�� s a� <br /> � � l <br /> C�e�)�' � �c,��r� �n��s�' � 3307 �y�_G'et�Id��r- i�� "�/'1 <br /> Owner Mailing Address Ciry Zip Phone <br /> �_� <br /> App icant Mailing Address City Zip Phone <br /> De..:rll�s Proposed Work �f�yL �r� <br /> Froject Address(if known) �f v� 1 ����� I705— EDlrE/»Oo Lf��/ �� � <br /> � <br /> Atlach lour(4)cnpies of plans lor proposed wurk- Draw�o scale and note ihe following as applicable: � <br /> • Property Lines • Centerline of street � <br /> � Outline and dimensions of all existing and ? Indicate North <br /> proposed structures on the lot • Siiow any proposed gradi�g changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> P[RMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be pertormed in accordance with this permit and current City ot Everett Design and Construction <br /> Standards and Specifications <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE YUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> �(� ACKNOWLEDGEMENT OF CONDITIONS <br /> ��ly l7 <br /> t��r y The undersigned ovmer/applicaN hereby agrees to hold and save harm- <br /> less the City ol Everett Irom any and all claims lor damages, costs. <br /> . / / expenses, or causes of action that may arise because of installation <br /> � „!/ ����j_ �n/��/�� and mainlenance of the improvement or other right-of•way use hnrelo <br /> �� '`�� �� applied lor ml lurther agrees to remove same upon notice frort� the <br /> Approved lor Co�tryc �on Date City an eplace public proper damaged thereby <br /> ��i ��, <br /> �T/ � �'.� 7 , � <br /> FINA N ECTION ' Date �r �� <br /> Approved as Constructed Sig re Applicant Date <br /> evere�t PUBLIC WORKS DEPARTMENT WORK A HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarSt�eet 1B0 DAYS OF DATE PERMIT IS ISSUEU AND THEREAFTER IS TO <br /> Evereit,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON 7HI5 <br /> PROJECT OVER 90 DAYS DURATION. <br />