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_�: <br /> _ _ - __-� <br /> , <br /> �� <br /> DBte �� Pu�l¢WorMs Permlt• <br /> 31Oq.Oapl.• <br /> A.pplication For <br /> PUBLIC WORKS PERNAIT P°°°°W°«.F°° . <br /> Totel Fee <br /> Leae AOD�Fee P�IE S <br /> Bd18ME�IIB � <br /> Print or Tyoe Only <br /> l�rBZ ��N' �a��v f38c�7 E.v��o,u �� ��-r 98z.D� Ssa-28�/ <br /> Owner Mailing Address City Zip Phone <br /> �Z� <br /> Applicant Meiling Address City Zip Phone <br /> Describo Proposed Work _1yJ�L "` Gl�L �LYL'��lL <br /> W <br /> Pro�ect Address pf know , ��7� ���1 C-' � <br /> Atlech four(4) copies of plans for proposed work-Draw to scate and nole Ihe following as applicab�e: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all exi,ting and • Indicate North <br /> proposed structures on the lot � • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall he made 24 hrs. in advance• phone 259-881 5. � <br /> 2. All work shall be Ger�ormed in accordance with this permit and currenl Ciry ot Everett Design aod Construction <br /> Standarils and Specificetions. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �J ��,�in/i X/�' �'��a'��r��/_� � /6/8� � <br /> �-�� H <br /> N <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned nwner/applicant hereby agrees to hold and save harm- <br /> less ihe Ciry of Everelt from any and all claims tor damages, costs, <br /> expenses, o� causes of action that may arise bacause of installation <br /> and maintenance of lhe improvement or other right-ol-way use hereto <br /> � applied lor and further agrees to remove same upon notice irom the <br /> Approved tor Construction Date City and to replace public property damaged thereby. <br /> � FINAL INSPECTION Date <br /> � Approved as Conslructed Signalure of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 UAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT A7AY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8015 PROJECT OVER 90 DAYS DURATION. <br />