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Date�LCL/Gl ! • • P�plic Works Permil s <br /> _ � <br /> Application For eia9.oao�.x <br /> PUBLIC WORKS PERMIT Pu0litWarksPea S --__ <br /> Totel Fae <br /> Lxas AppL Fee Peitl �— <br /> Balanca Due S <br /> Print or Type Only � <br /> �U4.U� L,�,es-av ��i s�f/�4���.e ,c�� E-.�r��o� <br /> Owner Mai4ing Address City Zip Phone <br /> I,�vco.� S,�c_ �ios�-E� cA.��r.o�r/ lsf,sv F�r 9azo� �338-is�f�S� <br /> Applicant Mailing Address ity Zip Phone <br /> Describe Proposed Work <br /> ,�v,� F�-,� d�- .f- ,� Tio (�J <br /> Project Address(if known) 2�y— ��E � � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the tollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all exisling and o Indicate North <br /> proposed structures on the lot . • Show any pmpoaed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> � DO NOT WRITE BELOW THIS LINE O <br /> PERMlT CONDITIONS <br /> 1. All calls for inspaction shall be made 24 hrs. in advance-phone 259-881 5. � <br /> 2. All w�rk shall be pertormed in accordance wilh ihis permit and current City of Everett Design and Consiruction <br /> Standards and Specitications. <br /> 3. Call l.ocation Underground Service 48 hrs.before you dig.TOLL FREE NUM9ER 1-800-424•5555. � <br /> /�0 /!`C�'G/G `!/O•P,fS' /�iP/j1/%/�E_ 'e�'/i.F-'�,U O <br /> �J JJ/8 .9S f/� <br /> �_J j�'G'�' l ` y♦ <br /> / O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> 'ihe undersigned owner/applicant hereby agrees to hold and seve tiarm- <br /> less the City of Everett irom any and all claims for damages, costs, <br /> - expenses, or causes of action that may arise because of instaliation <br /> and maintenance ot the improvement or other right�of-way use hereto <br /> applied for and further agrees to remove same upon notir,e from the <br /> Approved for Constri!atiur. Date City and ro replace public property damaged thereby. <br /> FINA�INSPECTION Date <br /> %�FFrwrd as Constructed Signawre ot ApplicaN Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUEG TO COMPLETION.7HIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PFOJECT OVER 90 DAYS DURAT�ON. <br />