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� _ <br /> Date � � � � Pu�l¢WorkSPB�mp+p <br /> Bmp Dept.e O� <br /> Application For <br /> PUBLIC WORKS PERMIT PubTotelFeeFee S - <br /> Less fno�.Fse PaW 5 <br /> � p„lancc Ouc $ <br /> Prirt or Type Only <br /> �_l��Preov� Ilnl ���jr,���- rvniPff ��3�1 �.SB —a�tQ7 <br /> Owner Mailmg Atldress Gry Zip Phone <br /> G ,. � _ . �G� <br /> ppliwnt Mailing Address City Zip Phone <br /> Describe Proposed Vlork �n ii/�nl A-�C�n' �H��,�'^.�'�� <br /> � <br /> Prolect Address(it known) � <br /> Atlach four(4)copies of plans lor proposed work- Draw to scale and nole the tollowing as applica6le: � <br /> • Proper�y Lines • CeN.�rline of street � <br /> • Outline and dimensions of all existin�and • Indicate Norih <br /> p�oposed siructures on the lot • Show any proposed grading changes <br /> • Existing and proposed ulilities • Show measurements � <br /> DO NOT WRI'.'E BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7. All calls lor inspection shall he made 24 hrs. in advance- phone 239•861 5. � <br /> 2. All work shall be perfonned in acrordance with Ihis permit and current Cily ol E-verett Design and Construc�ion <br /> Standards and Specilications. <br /> 3. Call Location Underground Service48 hrs. before you dig.TOLL FREE I�UMBER 1-800•424•5555. � <br /> yo our3�.� wo�,r�r- ,�.��r.�c=CQ�.,�.<o /—a/—A� � <br /> �� r <br /> N <br /> O <br /> a <br /> P.CKNOWLEDGEMENT OF CONOITIONS <br /> The undersigned owner/applicant hereUy agrees to hold and save ha�m� <br /> less the City ot Everetl trom any and all claims tor Aamages, cosls. <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance of the improvement or other righFof�wa! use hereto <br /> applied and furiher agrees lo remove same upon noti�a from lhe <br /> Approved tor Cons�ruction Date City a d t replace public pr rry damaged thereby. <br /> 3- � O-�7 <br /> HNAL INSPECTION �a1e " Date <br /> Approved as Constructed Signa�ure ol Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everMt PUBLIC IYORKS DEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. TfIIS PERMIT MAY BE <br /> [verett,WA 98201 CANGELLED DV 7HE CITY UPON ANV STOPPAGE OF WORK ON 7HIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />