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�30•8 Publit Wo:ks Pnrm��s�� 1 �� <br /> Date_r <br /> Applir.ation For AIdO�Depl.• '� <br /> PUBLIC VI/ORKS P�RMIT PutlicWorksFeo <br /> To�e�Faa s �o . o c <br /> �ass noot Fae ram S_- <br /> � <br /> eaiance oue $�-O_d O <br /> Print or Type Only <br /> �; �, �s�__ <br /> �r � ��, ��? ���'S �S3a- b�'3.�'�k'� s� .�e�����1��.s' 33�-�,�! <br /> O�mer Mailing Adtlress Ciry Zip Phone <br /> �� 3/f/l� -1=ct;,c�!'� � �e%i�� �82-c�l a-5�-<fl 7/ <br /> Apolicant Mailing Address Ciry Zip Phone <br /> Describe Propesed Wor!c �� /�' ✓D �`rc 1 Gg�� �/'��L ! y�G�,l <br /> r <br /> � <br /> Prolect Address(if known) � � L'" r ' � � � C- ~ <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street /A <br /> ! Outline and dimensions of all existing and • Indicate North V� <br /> proposed structures on the lot � Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. All calls tor inspeclion shall be made 24 hrs. in advance- phone 259-881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Gesign and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> O <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold snd save harm- <br /> less ihe Cit� of Everetl from any and all claims for damages, costs, <br /> / expenses, or causes of action that may arise because of installation <br /> S-�_�y a.�d maintenance of the improvement or other right•ot-way use hereto <br /> � �- applied for and (urther agrees to remove same upon notice from the <br /> pproved(or Jonstruction J a1e City and to replace public property damaged thereby. <br /> l .�S�i['���� �-'�y Cra�cc�� J� � �l <br /> FINAL INSPECTION Date ����CG <br /> Appreved as Construcled Signature of Applicant ate <br /> WORK AUTHORIZED BY THIS PERtv11T MUST BE STARTED 6VITHIN <br /> everett PUBLIC WORKS DEPARTMENT 1gp OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURkTION. <br />