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Date ��G-� � � P�o���wo�.�P�,m�,� rs'8 / 9 <br /> Application For <br /> eie9.oeo��+ <br /> PUBLIC WORKS PERMIT Pu�l¢Wa�ksFee <br /> Totai Fee $ <br /> Less Appl.Fee PaiO � <br /> 2D po <br /> Balance��e S �� <br /> Print or Type Only <br /> i��� L�� ,��iP�� � i � i ln ��t,f��� c�4�� �s��i ���a-1�50 <br /> Owner Mailing Address City Zip Phone <br /> ��� <br /> Applicant Mailing Address City Zip Phone <br /> Descri�e Proposed Work �` wr" `C��� — <br /> ^����{ I/�y� � <br /> Prolec�Address(if known) n����I / �� �T��K �1— � <br /> Atlach four(4)copies of plans for proposed work- Draw to sca'e and note the following as applicable: � <br /> a Property Lines • Centerline of sireet � <br /> • Outline and dimensions ot all existing and • Indicate North <br /> proposed 5tructures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT\NPITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be peAormed in ac:ordance with ihis permit and current Ciry of Everett Oesic�n and Ccnsiruction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 4B hrs.betore you dig.TOLL FREE NUMBER 1•800-424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> �CKNOWLEDGEMENT OF CONDITIONS <br /> y�� The undersiqned owner/applicant hereby agrees to hold and save harm- <br /> less the City ol Evere�� Irom any and all claims for damages, costs, <br /> expenses. or causes of aclion that may arise because ol installation <br /> � and maintenance of the improvement or other right-ol�way use hereto <br /> �� '� `j/�8 applied lor and luriher agr Qs to remove same upon notice Irom the <br /> Approved lor Cong�uction 1 Date City and to replace public roperty dama9ed thereby. <br /> I <br /> �_, <br /> FINAL INSPECTION Date ��d 1 �� "?—���— <br /> Approved as Constructed Si of q plicant Date <br /> WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED N.'ITHIN <br /> everett PUBLICWORKSDEPARTMENT 7g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTE;i IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERM'i MAY BE <br /> Ewretl,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAY.S DURATION. <br />