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a� <br /> ra <br /> oate y �E/�?� PeeiicWodsPamit� <br /> � BIC9.Dept.s 41�/ � �� <br /> Application For <br /> PUBLIC WORKS PERMIT P�bTotaFeaFee 5 <br /> Less AppL Fee PeiO � <br /> ea�zoce ooe S <br /> Print or Type Only <br /> CL-���'� E ��vour� �o�+-v,1_.�� ,2SVL- ����,sov. Cv . 9F�2o.3 3�S�7t6%' <br /> Owner Mailing Address City Zip Phone <br /> �L}.MG — <br /> Applicac' Mailing Address City Zip Phone <br /> Describe Proposed Work _ Y���" ��u/�' � �p�� �` � "/ f� <br /> .C��I/��Q.,i" a.�it� a �a c� �.'6 u�/C� i s� 2 (-•!�r/t�on�y/S — <br /> o _ W <br /> Project Address(if known) ���� \"'-`�— "" ' ' — � � <br /> Atlach four(41 copies of plans for prcposed work Draw to scale and note ihe following as applicable: �° <br /> • Property Lines • Cen�erline of sireet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed struc�ures on ihe lot • Show any proposed grading changes <br /> • Existing and proposed utililies • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE o <br /> PERMIT COND�TIONS <br /> 1. All calls for insp.ction shall be made 24 hrs. in advance- phone 2S9•881$. � <br /> 2. All work shall be performed in accordance wili�this permit and wrrent City ot Everett Design and Construction <br /> Standards and Specl'icationa <br /> 3. Call Localion Underground Service 48 hrs. bef�re you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �,,,,, <br /> k5 � O <br /> N Pw� �, � �eSu�` � <br /> u � <br /> � , o� � <br /> �-/� °/ a. <br /> f.CKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City ot EvereV from any and all claims for damages, cos�s, <br /> expenses, or causes of action that may arise because of installaGon <br /> and maintenance ot the improvement or other righ4ohway use hereto <br /> applied tor and furlher agrees to remove same upon notice irom the <br /> Approved for Construction Date Cit/and lo replace public properly damaged thereby. <br /> , <br /> � FINAL INSPECTION Date Date <br /> npproved as Constructed Signalure ol Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evcrett PUBLIC WORKS DEPAflTMENT 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3YU0 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Lverelt,WA 98201 CANCELLED CY THE CITY UPON ANY STOPPFGE OF WORK ON THIS <br /> Phone. 259-8875 , PROJECT OVER 50 DAYS DURATION. <br /> I --� <br />