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/�,I (}� � <br /> [�8te�.�! "�/ � Pu�Oc Works Permpil•p <br /> Application For o�ae Deo�.•_—OS]_��� <br /> PUBLIC WCZRKS PERMIT PubiitWo�ksFee <br /> Tnipl Foa S <br /> Less ApPI Fec Pad � <br /> BalanceDue $ <br /> Print or Tvpe Only <br /> �i� -.r,v��s�r�t a�� �a(ev�.c� � � '!1�►-�. ��-1�3 <br /> Owner Mailing Atldre_�s Gity Zip Phon�� <br /> Applicant Mailing Address Cdy Zip Phone <br /> i� <br /> T'E.vA.u7' (� 1 JT rl?. /�I�In .l1Sl� " <br /> Describe Proposed Work --- <br /> -rmP <br /> W <br /> ProiectAddresslifknown) ��� `S�- E�%/�JFLL ' � • � <br /> A[tach ;our�4)copies ot plans lor proposed work- Draw to scale and nole the following as ap{�licable: � <br /> • Property Lines • Centerline af sireel � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposeo siructures on ihe lo� • Show any p�oposed gradinc� changes <br /> • Existing and proposed u�ilities • Show rneasuremen�s � <br /> �i <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> t.All calls lor inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be performed�n accurdance with this permit and current Ciry of Everett Design and Construction <br /> Standards and Specilications. <br /> 3.Call location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> a/��/ae � <br /> n��T ��� �- <br /> �'� � <br /> O <br /> a <br /> ACKNOWLEDGEMEN7 OF CONDITIONS <br /> The undersi9ned owner/applican�hereby ag�ees to hold and save harm• <br /> less lhe Gty ol Everetl trom any and all claims lor damages. cosis, <br /> ezpenses, or causes of action that may arise because of installation <br /> and mainlenance of lhe improvement or olher right-ol-way use herelo <br /> applied lor and �wther agrees to remove same upon notice Irom the <br /> Approved for Cons�ruction ��« City and to replace public property damaged Ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Cons�ructed Siqnature ol Applicant Date <br /> WORK AUTNORIZC-� BY THIS PERMIT MUST BE STARTED WITHIN <br /> everell PUBLICWORKSDEPARTMENT 180 DAYS OF OATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV 8E <br /> Everetl,WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phene�.259�8810 pROJECT OVER 90 DAYS DUf�ATION. <br />