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Date ^ - o�„�<<}o,�.��.,m�. <br /> Applicati0n For o��e o�ai . <br /> PUBLIC WORKS PERMIT P�o�,=W�,ksF�� -- <br /> Total Fee 5 <br /> Less ppP�Fee Paid S <br /> Print or Type Only R��,�=�o�� s <br /> ll i?�EO�h� �/t�+�rS-e� <br /> Owner Mailing Address City Z.ip Phone <br /> Applicant Mailinc�Address City Zip Phone <br /> Descri6e Proposed Work b1N'="Y �� <br /> Prolect Address�if known) � �— -E �Ut q (�J � <br /> Attach four(4) copies of plans for proposed work- Draw to sr.ale and note the following as applica fe: � <br /> • Properry Lines • Centerline ol street � <br /> • O�Gine and dimensions of all existing and • Indicate North <br /> proposed siructures on the lot M Show any proposed grading changes <br /> • Existing and proposed u�ilities • Show measurements � <br /> �O NOT WRITE BELOW Ti115 LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with this permit and current Ciry of Everett Design and Cor�struction <br /> Standards and Specitications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•$00•424-5555. � <br /> ��U.LLc`�� C::'ov�=_f�.�PiLru.7 /lfi9t /CQ�. O <br /> 4��'��� /�%�" H- <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT Or'CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less ihe City of Everett trom any and all claims for damayes, costs, <br /> expenses, or causes of actiun that may arise because of ins�allation <br /> and maintenance ol the im{;rovement or o�her ri�hi-of-way use hereto <br /> applied for and lurther agrees to remove same upon nohce Irom ihe <br /> Approved for Construc�ion Date Cdy and to replace puUlic property damagetl �hereby. <br /> FINAL INSPECTION Date <br /> Approved •as Constructed SignaWre of ApPlicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERM!T MUST BE STARTED V✓ITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 �E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br /> Pnone:259�BB70 CANCELLED BY THE CITY UPON ANY STOPPAGe OF WORK ON THIS <br /> � PROJECT OVER 90 DAYS DU�?ATION. <br />