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��� � <br /> bs � . . _. - <br /> ��� Date �� ��o���wa�wsa�,m . _ <br /> Application For eiae o�,i.• <br /> p�� PUBLIC WORKS PERMIT P��to�nFee�eB : <br /> ��/1�"1 Less POD�Fee Paio S — <br /> �r Balance�ue S <br /> Q P� Print or Type Only <br /> rov <br /> Q�� �7 � � <br /> �>. Hg{� � Maili ddress City Zip Phone <br /> ryH <br /> N <br /> �� <br /> �� qpplican� Mailing Address City Z�D Phone <br /> ��� DescriAe Pronosed Work �`-'� <br /> fA <br /> � Proiect Address lit known� / � � i <br /> — � <br /> A�tach lour(4)copies of plans lor proposed work•Oraw to scale and note Ihe lollowing as applicaUle � <br /> • Property Lines • Centedine ol streel /A <br /> • Outline anA dimensions of aU existing and • Indicale Norlh V/ <br /> proposetl siructures on ihe lot • Show any proposed grading chcn�es <br /> • Existing antl proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW ThiIS LINE O <br /> PERMIT CONDITIONS <br /> � 1.All calls for inspection shell be made 24 hrs.in advance-phone 259•8810. � <br /> '�1 2.All work shall be pedormed in accordance with this permit and current Ciry ol Everett Design and Conslruction <br /> '_' Standards and Specifications. <br /> 3.Cell Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> 11 � <br /> 1_I <br /> �� �������w���� �. � <br /> � � <br /> ! ����cJ� O <br /> �_' z z 3-9� a <br /> - <br /> I- <br /> 11 <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> � <br /> The undersigned owner/applicanl hereby ac�rees to hold and save harm• <br /> �' less the City ot Everett Irom any and all claims lor damages. costs. <br /> expenses, or causes of action Ihat may arise because ol installat�o❑ <br /> f and maintenance ol Ihe improvement or other righl�ol�way use hereto <br /> applied lor and lurlher �g/ees to femove 5ame upOn noliCe Irom Ihe <br /> � Approved for Construction Date Cily and lo replace public pronerty damagetl ihereby. <br /> FINAL INSPECTION ���e <br /> Approved as Constructed Signature ol Applicant Da1e <br /> �eacrett1 PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERM1IIT UUST BE SiARTEU WITHIN I <br /> I 3200CederSireel iB0 DAVS OF DATE P[Rh11T IS ISSUED AN� THEREAFTEA IS TO I <br /> U Everet4 WA9B201 BE DILIGENTLY PURSUED TO COMPLETION THIS PERMIT MAY B[ <br /> CANCELLED BY TH[CITY UPON ANY STOPPP.GE OF WOFK ON THIS <br /> P�one:259�8810 PFpJECT OVER JO DAYS DURATION. <br /> f <br />