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"_ __ <br /> / C '_' <br /> pa(g ��� � G� a�ni�r,wo��saormi . <br /> Application For ema.oen�.r � <br /> PUBLIC WORKS PERMIT P��IicW��kSFeo <br /> ,e�e�Fee s <br /> �essaoo�Fanva��o 5 <br /> Print or Type Only B=:e��a o�a s <br /> '�-� j lo� �'! `-Q-�.� SL� � v/� � " 7��- ( x�sl— 7��i <br /> Owner Mailing Address City Zip Phone <br /> �h�� <br /> Applicant Mailing Atldress City Zip Phone <br /> Descrite Proposed Work C C`-^���`--�- <br /> Prolect Address(if known) � " � <br /> � <br /> Attach four(4)copies of plans for proposed work- Draw�o scale and note ihe lollowing as applicable: �� <br /> • Property Lines • Centedine of street /A <br /> • Outline and dimensions ot all existing and • Indicale Norih V� <br /> proposed st�uctures on the lol • Show any proposed grading changes <br /> o Existing and prop�sed utilities • Show measuremen�s � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t. All calls for inspedion shall be made 24 hrs. in ativance- phone 259-881 5. � <br /> 2. All work shall be performed in acwrdance with Ihi� permit and current City ol Everetl Design and Construction <br /> StandarAs and Specitications. <br /> 3. Call Location Underground Service 4B hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> ��.l� / �i�/nl � ��O'� ���/��� r� <br /> ' �� � <�� V♦ <br /> , O <br /> a <br /> PCKNOWL[DG[MENT OF CONDITIONS <br /> The undersigned ov:ner/apP�icant hereby a9iees to hold antl save harm� <br /> I less Ihe Ciry ol Everett from any and all claims lor damages. costs, <br /> expenses, or causes ol adion that may arise because ol installation <br /> and maintenance of the imp�ovement or other ngh�-obway use hereto <br /> apP�ied for and turther agrees lo �emove same upon noticr Irom the <br /> Apprwr_d lor Constr�ir,lion Datr City and to replace public property damaged Ihereby. <br /> FINAL MSPECTION Dr+le <br /> Approvetl as Cmistructed Signalure of Apphcant Date <br /> evrrel[ PUBLIC':"JORKS DEPARiMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 1d0 �AYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA 98201 BE DILIGENTI.Y PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br /> Phone�. 259�8815 CANCELLED BY THE CITY LIPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />