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�8te_�/ PuELc Works Permlt• <br /> O 9 <br /> ema.oeoi.. tB6 — �7 '-9 <br /> Application For <br /> PUBLIC WORKS PERMIT P°°Ta„°Fe`°° : <br /> Leaa RGGL Fee P�IU f <br /> Bebrce0ue • � ��e6E <br /> Print or Type Only <br /> J�% �'a ii..::i...� ��22 �yEIJ/'lT �c/Eti'E�'T /8Z0� <br /> Owner Mailing Address City Zip Phone <br /> Applicant Meiling Address City ZiP Phone <br /> Describe Proposed Work CH/�' '��'�EG <br /> W <br /> Pro�ect Address(if known) �9 — �E���_ 9��' � <br /> Attach four(4)copies of plans for proposed work• Graw to scale and note Ihe tollowing as applicable: � <br /> � Property Lines . • Centerline of street � <br /> • Outiine and dimensions of all existinp e id • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> � Ezis!ing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shell be made 24 hra in advance• phone 259•881 5. � <br /> 2. All work shall be pertormed in accordance with this permit and currenl City ot Everett Design and Construction <br /> Stendards end Specifications <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> F�itJ� �S/DEt�Y9G� �i�a�aED �G�zi2Cs Ti.'�5 O <br /> �O.t1ST,eriCTiOnJ H'lc'-� 8E �C'�i�c/aC�.�� *''j� � <br /> TNE ��.�Ait�P' V/ <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all cleims lor damages, costs, <br /> � /� / expenses, or causes of action that may arise because of inslallation <br /> C'������.,^—!l �a�y�y and maintenance of thfi improvement or other right•of•way use hereto <br /> """ E��r�o-�.•c• / `" aPPlied for and further agrees to remove same uPon notice irom the <br /> Ayproved for Cons ruclion a1e City and to replace public property damaged thereby. <br /> y'—J�—�j ���_ f,F 2 —2 � —�� <br /> FINAL INSPECTION Date Dete <br /> Approved ae Constructed Signature of Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMC-NT �g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURtiUED TO COMPLETION.THIS ?ERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8815 PROJECT OVER 90 D4YS DURA710N. <br />