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Date�7 PublicWorkSPermi�s �� �/ � <br /> Applicalion For eiae�oen�.: � � ��� <br /> �— <br /> PUBLIC WORK� PERMIT PueTotalFeeFee g <br /> less AppL Fee PaiC � <br /> Print or Type Only <br /> Balence Dua S Q 00 <br /> l��n,,��� %n ✓/— Poti- �/�1r1��2Cl� 1— O�C-Z7� �.F,20/ d S9-o7S��S <br /> `bwner ^�v ailmg Address Ciry Zip Phone <br /> � Sa w,,� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work �.1 / , 4 f �� �sL1��� U�(�/ <br /> Prolec�Address(if knowN � �T���Jfi/ � <br /> --7 � <br /> Atlach four(4) copies of plans tor proposed work- Draw to scale and note the tollowing as applicable: � <br /> • Prope�rry Lines • Centerline of street � <br /> • Outlin=and dimensions of all existing and • Indicate North <br /> propossd structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE ^ <br /> PERMITCONDITIONS l ! <br /> r <br /> 1. All calls for inspecliun shall be made 24 hrs. in advance- phone 259•Li81 5. � <br /> 2. All work shall be performed in accordance with this permit and current City ot Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you di�.TOLL FREE NUMBER '!-$00•424•5555. � <br /> O <br /> ■ <br /> � <br /> � <br /> � <br /> ,;,��� ACKNOWLEUGEMENT OF CONDITIONS <br /> ���� The und:rsiyned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages, cosls, <br /> /� expenses, or c2uses oi action that may arise because of installation <br /> ' �0��3� � 2� 8,7 and m intenance of the improvemenl or other ri9ht-ol-way use hereto <br /> Approved for Construc ' applie tor and fu�er�rees to remove same vpon notice from the <br /> Date City a d to replar./ li6 c p� perty damaged thereby. <br /> FINAL INSPECT� �������Date �����• � <br /> Approved as Constructed ignature of Applicant � Da e <br /> everetl PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARI'ED WITHIPi <br /> � 3200 CedarSireet 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett, WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED �Y THE CITY UPON ANY STOPPAGE Of WORi<ON THIS <br /> PROJECT OVER 90 DAYS DUflATION. <br />