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I <br /> � <br /> i <br /> :�► � <br /> ' � � <br /> Date � y �� 1'ellic WorFs^�rmil• <br /> ApFlicalion For eieo.oen�� �. <br /> / a 6 7,"" <br /> PUBLIC WORKS PERMIT PubTnNFeeFoe s ; <br /> Leas F00�Fae.^eld S �� <br /> Balence Oue S I <br /> Print or Type Only <br /> /'���ua.��—��, �d.ed ��/ � �� ,��y---� �• 1���aI I <br /> Owner � i Mailing Add ss City Zip Fhone '� <br /> �� �f <br /> Applicanl Mailing Address City Zip Phonn <br /> Describe Proposed Work � L <br /> W <br /> � Prolect Address(il known) ��� sC �� � <br /> � Attach lour(4)copies of plans for proposed work• Draw lo scale and note the Ioliowing as applicable: � <br /> • Properry Lines • Centerline of sireet � <br /> • Oulline and dimensions ol all exist�ng and • Indicate Norih . <br /> � proposed slrucWres on the bt • Show any pwposed grading changes 'I <br /> • Existing and proposed utilitles • Show measurements � I <br /> � DU NOT WRITE BELOW THIS LINE � <br /> � PERMITCONDITIONS O <br /> � 1.All calis for Inspection shall be made 24 hrs.in advance•phonc 1.59-8810. � <br /> � 2.All work shall he peAormed in accordance with lhis permil and cunenl City of Everett Design ead Construcllon <br /> � Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FAEE NUMBER 1•800-424-5555. � <br /> �v�� ��a-Z,� �� /L!:,�`,�� , � <br /> �'�� ~ I <br /> � <br /> � -2 �-'i � � <br /> a <br /> ACKNOWLEDGEn7FM 7i'CONDIfIUNO <br /> The undersipned owner/applicant hereby agrees lo hold and save hanm <br /> � - less the Ciry of EvSrett irom any and all cleims lor damages, costs, <br /> expenses, or causes ol aclion that may erise because of Instellalion <br /> and maintenance ol Iho improvemenl or other righbof-way use herelo <br /> ' - applied lor and further aprees to remove seme upon notice Irom the <br /> �. Appr.�ved lor Conslruction Date City and lo ieplace public property dama9ed thereby. <br /> FINAL INSPECTION Dalo <br /> Approved as Conelrucled Sic�naluro o!Applicanl Dete <br /> WORK P.UTHORI2ED BY THIS P[RMIT MUST BE STARTED WITHIN <br /> everett Pi.9LICWORKSDC-PARTMENT 1D0 DAY3 OF DA7E PERMIT IS ISSUED AND THEREAFTEF IS TO <br /> � 3200 Ceder Sireet BE DILIGENTI.Y PURSUED �O COMPLETION.TIiIS PE�iM1T MAY BE <br /> Everett,WA 98201 CANCELLED PY THE GITY UPON ANY STOPPAGE OF WORK ON TFIIS <br /> Phonc:259-8610 pROJECT OVER 90 DAYS DURATION. � <br /> I <br />