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Date�L� Pubi�c Works Permi ��—�2� <br /> i <br /> eiee oeo��+ " <br /> Application For <br /> I�UBLIC WORKS PERMIT P°°hpWOfk$FeO <br /> Ta�,�Faa S <br /> Less rlo0l Fee Pa�O � <br /> BaIenCYDVP S 2�-�— <br /> Print or Type ��nly <br /> ��`� �� ���� �/�.,9 .��,�--� �s9--���y <br /> Owner Mailing Address � �.ip Phone <br /> Applicant Mailin9,4dtlress City Zip Phone <br /> Describe Proposed Work ��i � <br /> v <br /> - W <br /> Proleat Address(if knownl — � ?�� � <br /> Attach lour(4)copies of plans for proposed work- Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline ol stree� ♦A <br /> • Outl�ne and dimensions of all ezisting and • Indicale North V� <br /> propused structures on the lot • Sho�u ar.y proposed grading changes <br /> • Existinc� and proposed utililies • Show measurements wq <br /> W <br /> DO NOT WRITE BELOW THIS LIN� o <br /> PER411T CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•SF31 5. ^ <br /> 2. All work shall be pertormed in accordance with ihis permit and curreM City ot Everett Desic�n and Construction ♦ <br /> Standards and Specilicaticns. <br /> 3. Call Location Underground Service 48 hrs b?lore you dig.TOLI.FREE NUMBER 1•8U0•424•5555. � <br /> O <br /> � <br /> N <br /> O <br /> a <br /> ((( ACKIJOWLEDGEMENT OF CONDITIONS <br /> � —_ The undersigned ownedapPlicant hereby agrees�o hold and save harm� <br /> less the City ol Everett Irom any and all claims loi dameges. cosis, <br /> � expenses, or causes of action that may arise because of installalion <br /> ��� ``� -�L� and maintenance o� lhe improvement or other righbof-way use hereto <br /> �f)�� JO �^��/��l' � _ applied �or and lurihei agrees �o remove same upon notice irom Ihe <br /> Approved lor Conslruclion • � �a�e City and to replace pub'ic property damaged thereby. <br /> � �L� Y��-C � . , � � <br /> ,,% �-li <br /> FINAI INSPECTION �a�e � - � �� ��'-- <br /> Approved as Consiructed Signature of A lic nt Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everelt PUBLIC WORKS DEFARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIG[NTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Eveiett, WA 9B2C1 GANCELLED BY THE GTY UPJN ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259�8815 oROJECT Ob'ER 90 DAYS DURATION. <br />