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i ` <br /> ; <br /> � <br /> � { <br /> I <br /> I <br /> _ / <br /> v„ni,c wo,ks a �� ��� <br /> DateSr� <br /> BI49 DeO��� �—. <br /> qpplication For <br /> PUBLIC WORKS PERMIT Po�imWodsFee <br /> Totai Fee s <br /> Less Ropl Fa.e PaiO $ O <br /> 9a�anca Due $ �C n <br /> Print or Type Only <br /> � <br /> �a ► �ic� �� i i I ��rn�� �b►� r-!,a2r � �� �,/r�►2�rr- ��� <br /> Owner Meding Atldress Cdy ZiP Phone <br /> Applicant Mailing Address City Lp Phone ,I <br /> �r�� Describe Proposed Work — <br /> — _ . W , <br /> � <br /> /�os— � �/��Ir.s���wT � ' <br /> Project Address(il known� -- <br /> Attach lour(4) copies of plans for proposed work- Draw to scale and note ihe following as applicable: � <br /> ��, • Property Lines • Centerline of streei �A �. <br /> � • Outline and dimensions ol all existing and • Indicate Norih V� I <br /> proposed s�ruc�ures on the lol • Show any proposrd grading changes <br /> • Existing and proposed utilities • Show measuremer�s � <br /> DO NOT WRITE BELOW THIS IINE O <br /> PERM!T CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All work shall be pedormed in accordance with this permit and current City of Everett Design and Construction <br /> � Standards and Specifications. <br /> 3.Call Location Underground Servicr.48 hrs.before you dig.TOLL FREE NUMBER 1-80b•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold a�d save nurm� <br /> � ��� less the Cily of Everett Irom any and all claims lor damages. cosls, <br /> / // / expenses, or cuuses of action ihat may arise Uecause of installat:on <br /> � � r /, � /� / /��c? and maintenanr.e ot ihe improvement or other righPo4way use hereto �I <br /> G2..� c�-�7-� u�i.� � ap d for and furiher agrees to remove same upon notice from the , <br /> Approved lor Construc ion � Date Ci y a d to replace p bli prop amaged thereby. <br /> � �O � � �` C � <br /> ,,..� <br /> FINALINSPEC�'fO�V��''�s1y�� Date <br /> Approved as Gonstrucled Signature of Applicant ate . <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN , <br /> �180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMII' MAY BE � <br /> Everett,WA98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br /> I <br /> I <br /> I <br /> � <br />