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^ j .— - <br /> Pu�Lc\'Jorks Per t a � � <br /> Date� <br /> Bitlq.DeO��^� 1 � <br /> Appl�cation For <br /> PUBLIC WORKS PERMIT PueTOlaFeeFee S _ <br /> Less Ap01.Fee PaiC 5 <br /> Balance Due $—_ <br /> Print or Type Only <br /> ��/�arfi�� 1 � ' ,� �i ��I�� La�arr� �a���� �201 �a-�a� <br /> Owner Mailing Address City Zip Phone <br /> C"-' I Mading Address Ciry Zip Phone <br /> App.icant /` <br /> Describe ProPosed Work �_��,! � � ����—"� <br /> � <br /> Prolect Address(it known) ��I��'='f � <br /> � <br /> Attach four(4) copies of plans for proposed work• ['iraw to tcale and note the following as applicable: � <br /> • Property Lines , • Centerline of street <br /> • Outline and dimensions oF all existing and • Indicate North <br /> proposed structures on the loc • ��how any proposed grading changes <br /> • Existing and proposed utilities • St��w measurements /� <br /> W <br /> DO NOT WRITE BELOW THiS LINE � <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be pr,rfonned in accurdance with this permit and current City of Everett Design and Construction <br /> Standards and Specitica;ions. � <br /> 3. Call Location Underground Service 18 hrs. before you dig.TOLL FREE NUM8E�00•424-5555. <br /> �li� u��.s .������ nc� ����► �-,1- �; Q I <br /> ;��� � <br /> � <br /> 0 <br /> a <br /> ACKNOWLEDGEt+1ENT OF CONDITIONS <br /> The undersiyned owner/applicant hereby agrees to hold and save harm- <br /> less the Ciry ot Everetl trom any and all claims for damages, costs, <br /> expenses, or causes of action thal may arise because of installation <br /> and maintenance of the improvement or other right-ol-way use nereto <br /> applied for and turther agrees to remove same upon notice from the <br /> Approved tor Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION �afe Date <br /> Approved as Constructed Si9nature of Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TG <br /> � 3200 Cedar Street BE DILIGENTLY PURSUFD TO COMPLETION. THIS PERMIT MAY BE <br /> Everetl,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 pROJECT OV[R 90 DAYS DURATION. <br />