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Date�V I Pub�m Works Parmit a <br /> Applicaticn For aioo�oaoi.+.�L��� <br /> PUBLif,; WORKS P�RMIT PubhcWoiksFee <br /> ,o���Faa s— <br /> .essAppl Foo PaW 'Y__ _ <br /> Prirt or Type Only 3'a°`eo°' $ i— <br /> ����- f�rs�. 97 a�--�-/,��i�=-��,/�A �a�9 9�F�is 5a �-aa�S <br /> Ov.nar MailingAddress City Zip Phone <br /> pp��licant Mailing Address City Zlp ^hone <br /> DescribeProposedWork _ /L�/1/I��T1✓1n11lJ7!/P/�1/P�� FIeX�'7��� �/���i�i�� <br /> Project Address(if knoNn) ��(/�(�� o%(��� l.l���il//[+ / _ L <br /> r <br /> Attach four(4)copiF-ol plans for p�opesed work- Dra�v to scale and note ihe tollowin{� as apolicable: � <br /> • PropertF Lines • CentcrlineotsUeet /�► <br /> • OWlin:a�•�1 dimensiuns of all existinq and • Indicale North �j <br /> prcposec siructures on the lot • Show any pro��osed grading changes <br /> • Existing and proposed u�ilitie:�. • Show measu =menis � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. Ail calls lor.nspection shail be made 24 hrs. in advance- phone 259-831 5. � <br /> 2. All work shall be performed in accordance with this permit and current Gity of Everett De�ign and Construction <br /> Stacdards and Specifications. <br /> 3. Call Lc,cation Underground Service 48 nrs.before yo� dig.TOLL FREE NUMBER 'I-800•424-5555. � <br /> / L�.�i/� (�JU/_'.CS T7�i"i�v� ,?/OT �c'�-�l�G-7�'�'G� O <br /> �'�/��� � <br /> , <br /> � �,�i- <br /> �.T <br /> a <br /> ACKNOWLEDGEMENT OF CJIJDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City ol Everett irom any and all claims for damages, cos':s, <br /> expenses, or causes ot aclion ihat may arise because of installation <br /> and maintenance of the improvercent or olher righl�o��way use herc:lo <br /> applied for and furiher agrees lo remove same upon notice from ihe <br /> Approved lor Construdion Date City and ro replace public properry damaged thereby. <br /> FINAL INSPECTION Date — <br /> Approved as Constructed Signature ot Applicant Datc. <br /> everett PUBLIC WORI<S DEPARTMENT WOfiK AUTHORIZED Bl' THIS PERMIT MUST BE STARTEU WI'iH:N <br /> � 3200 Cedar Street 1B0 DAYS OF DATE PERMIT IS IS�UEC1 AND THEREAFTFR IS ''O <br /> C-verett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 9E <br /> Phone: 259-8815 CANCELLED BYTHE CITY UFON ANY S?OPPP.GE OF WORK ON TIiIS <br /> PROJECT OVER 90 UAYS DURATION. <br />