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i <br /> Date� y�, ✓` <br /> PUELCWo�NSPe� �:� <br /> Application For BIdB.Dep!.s� <br /> PUBL.IC WORK� PERMIT PublicWo�MSFea — <br /> TotelFee S__ <br /> Less Aopl.Foe Paitl $ <br /> ( Print or Type Only 9a�a��ao�� S�o�� <br /> � Y� ►`Y��rr� , a�q �a �� � � `�tf-�11 ��p,^yy�� <br /> uwner Mailinq Address pi�y Z�p�'+� Ph" '-"�' <br /> Applicant Mailing Address City Zip phone^� � <br /> Describe Proposed Work _ !�� <br /> Project Address(if known) ����— � �;,yrT �'- � q � <br /> Attach four(4)copiea ot plans�or proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines � <br /> • Centerline of sireet � <br /> • Outline antl dimensions of all existing and •lndicate North <br /> proposed structures on the lot • Show any proposed gratling chanyes <br /> • Existing and proposetl utilities • Show measuremenis <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1.All calis for inspection shall 6e made 24 hrs.in advence-phone 259•8810. <br /> 2.All work shel!be pedormed in accadance with this permit and wrrent City of Everett Design and Construction ' <br /> Standards and Specifications. <br /> 3.Call Location Undergrourd Service 48 hrs.before you dig.TOLL FREE NUMBER 1-$00•QQ4•5555. <br /> � <br /> O <br /> � <br /> � <br /> 0 <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> �Ole Izss ihe City of Everetl Irom any and all claims for damages, costs, <br /> '�� � /��� / espenses, or causes of action that may arise because of inslallation <br /> �i <br /> f �� g and maintenanr.e ot ihe improvement or ether right-of�way use hereto <br /> Approved f onstruction Date applied for and lurlher agrees to remove same upon notice from ihe <br /> City and to repla.e puhlic properry damaged thereby. <br /> FI L�G N 7C�,v� _����D e .�ory�� �,lE / � l�/ <br /> Approved as Constructed ' " — " n"'� /� <br /> Signalure ol," ppli ant Date <br /> evere[t PUBLICWORKSDEPARTMENT WORK AUTHORIZEi) BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 Dr1YS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMiT MAY BE <br /> Phone:259�BB70 CANCELLED OY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />