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� � <br /> Date ��� �� . � r�ee�woa:v �mp <br /> Application For amq ocac: � ���� <br /> PUBLIC WORKS F'�RIVlIT PummWorpsFee <br /> Tolal Fee 5 <br /> LeSSApP�-FeePaiE $—__ <br /> PrintorTypeOnly ea�a��oo�� 5_ __ <br /> ��U�C I ��t�� ��G1oo� Qf�. }' ��Il� � �'1'��C� ��Y' ��?C'�-/� <br /> Owner Mailing Add�ess City Zip Phone <br /> `J�I 1 � i _ <br /> Applicant Ma�ling Atldress City Zip Phone <br /> Oescribe Proposed Work ��(���� ��� ��L�T�L-�—C .Y�l��� _ <br /> r—��"�D'L-1�bQ�� — <br /> Project Address(if known) � � <br /> � <br /> Attach lour(4)copies of plans for proposed work- Draw to scale and note the lollowing as applicable: as <br /> ! • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicat� North <br /> proposed sVuctures on the lot ! Sho�v any proposed grading changes <br /> • Existing and proposed utilities • Shatv measuremenls � <br /> DO NOT WRITE BFLOW THiS LINE� <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•E8�0. � <br /> 2.All work shall bP pertormed in accordance with this permit and cu«ent City of Everett Design and Conslruction <br /> Standards and Specitications. <br /> 3.Call Location Underground Sarvice 48 hrs.before you dig.TOLL FItEE NUMBER 1-800-424-5555. � <br /> Co <br /> n��T- �C��I (��� � <br /> ;�/'G: / .�O/ �� � <br /> /f � <br /> � <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF CONOITiONS <br /> The undersigned ownedapplicant hereby a9rees to held and save 1'.ann� <br /> — less the Cily of Everett from any and all claims tor damages, costs, <br /> expenses, or causes of action ihat may arise because ol inslallation <br /> and ma�nten2nce of the improveinent ur other right-of-way use I�ereto <br /> - applied lor and further agrees to remove same upon notice L•om Uie <br /> Approved lor Constructio� Date City and to replaco public property dama9ed thereby. <br /> FINAL INSPECTION Date <br /> Approved as Consiructed Signature of Applicant Daiu <br /> everett PUBLICWORKSDEPARTMENT WORI< AUTHORIZ[D BY THIS PERMIT MUST BE: STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PFRMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett WA98201 BE DILIGENTLI' PUFSI'ED 70 COMPLETION. TH!S PEFMIT MAY BE <br /> Phonc:259-8810 CANCELLED BYTHE GI�Y UPON ANY STOPPAGE OFINOF'K ON THIS <br /> PROJECT OVER 90 DA�S DUR,ITION. <br /> - ._ .-_ _. .._ _ . <br /> Src .:; ., � ,c. S'. :;�. ,-, . - .. . .. ._ . . _;,;:�,� .�.... <br /> a i�,: ,e. r. (- a . <br />��.�u._...x.:r . ,i� � ... .d r( . �;_.!`t, , r�, - ,_,x._ � ._,., , . _ ' ^�YA.��_ <br />