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� <br /> Date �� � � (� � <br /> �� � PuOLctlorksPormits �� /—�� <br /> Application For eiao oea�.. � ��— <br /> PUBLIC VrIf�RKS P�RSVII'�' PueTotaFaeFee g <br /> Less FOPI.Feo Paitl 5 <br /> Bnlan�e Due $ <br /> Print or Type Only <br /> � <br /> ��1 � N\ c�,,..�- l���1 S `��v�.�IU� \���a��� ���o� � �3-03�z o <br /> Ow�er Mailing Address City Zip Phone <br /> �.�" �71 '�-- <br /> Apphcant Mailing Address City Zip Phone <br /> Descri6e Proposed Work I � /J`�--- . <br /> � � � <br /> Praject Address(if known) � <br /> Atlach fow(A)copies of plans lor proposed work- Draw to scale and note the following as.,pplicable: � <br /> • Property Lines • Centerline ot s�reel �^ <br /> • Outline and dimensions oi all existing and • Indicate North � <br /> proposed structures on the lot • Show any propose�grading changes <br /> • Existing and propoced ulilit�es • Show measurements � <br /> D� NOT WRITE BEL04NTHI5 LINE � <br /> PEqM1T CONDITIONS <br /> t. All calis for inspection shal. 5a made 24 hrs. in advance-phone 259�88�5. � <br /> 2. All work shall be perlormed in accordance with ihis permi�and current City of Everett Design and Consiruction <br /> Standards and Specificalions. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> r/,- / ° Ci _i <br /> ��, �(1-y� ;c./J/�j-Ji''�C�✓C ���fJ' �i /r� � I c�. -/�-G.✓ � <br /> / / <br /> �p <br /> V/ <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less Ihe City ot Everett irom any end all claims for dama�es, cosis, <br /> _��j�j' .� ,� expenses, or causes of action that may arise because of installalion <br /> / / � 7 �� and maintenance of the improvement or other right-ol-way use hercto <br /> ` epplied for and further agrees to remove same upon notice from the <br /> Appr9Ged for C fs wC ion Date lace public property damaged ihereby. <br /> FINAL INSPECTION r ---�� Date . L- '�-L "�S.S� <br /> Approved as Constructed ign tu f A licant Date <br /> evere[t PUBLIC WOFKS DEPARTMENT WORK AUTHOR D BY THIS RMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS UF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> E�erett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.'fHIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />