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�I��,� -. .^ <br /> Date P�o���wo,ws Pe,m��,�,, -� Y- �L <br /> Application For eiag oen�.���." � �— <br /> PUB�IC WORKS P�FiMlT P�blicWarxsFee <br /> Toial Fee S <br /> Le55A0P1 FeePaiA $ <br /> Balance Ooe $ <br /> Print or Type Only <br /> (� i�1 D C�� �� ��F'��`� <br /> O er Mailing Address City Zip Phone <br /> c- L,�.� l�� <br /> Applicant Mniling Address City Zip Phone <br /> Describe Proposed Work / `�� <br /> Project Address(il known) �1�� ( /��r/ L/.�(�LLc � <br /> � <br /> Attach four(4) copies of plans lor proposed work- Draw lo scale and note lhe lollowing as appliczble: �� <br /> • Property Lines • Centerline of sVeet /w <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 utili�ies • Show measuiemenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PFRMIT CONDITIONS O <br /> 1.All calls(or inspection shall be:nade 24 hrs.in advance-phone 259•881 O. � <br /> 2.All work shall be pertormed in accordance with this permit and current City ot Everett Design and Construction <br /> Standards and Specilications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-500•424•5555. � <br /> I'lc�l r�-�'�i rP_I_7 0 <br /> ���jy 86' �"� <br /> 7— � <br /> � <br /> �. <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/apPlicant hereby agrees to hold and save harm- <br /> less the City of Evere�t Irom any and all claims for damages, cosls. <br /> expenses, or causes of action iha� may arise because ol installa�ion <br /> acd maintenance of the improvement or other right-of-way use hereto <br /> applied for and further agrees to remove same upor notice Irom the <br /> Approved lor Construction Dale City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> ApprOveA as Constructed Signature ot Applicant Da�e <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERIAIT MUST 8E STARTED WITHIN <br /> � 3200CetlarSireet 180 DAYS OF DATE PERMIT IS I�IiUED AND THEREAFTER IS TO <br /> Everetl,WA 98201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON AN Y STOPPAGE OF 1NCRK ON THIS <br /> PROJECT OVER 90 D�YS DURATIOI`I. <br />