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�8�e � I 1 Y1�D� Puohc Wnr�s Pe�mil• <br /> �L1L� <br /> oiap Deoi.� <br /> Application For <br /> PUBLIC WORKS PERMIT PubbcWo�MeFea <br /> roiei vaa s <br /> Lnsa�oc� FeePeiA S <br /> Bolance Oue s <br /> Print or Type Only <br /> r �hlin in� i �i+�- �1v� �� q� ,n I ���-a��l <br /> Owner Mailing Address C� y Z�P Phone <br /> �� n�Q <br /> Appllcent MaJing Address Gty LP Phone <br /> Deacribe Proposed Work 1LJ1..'�" (O� ,�` �• <br /> �' <br /> �l w <br /> � �oi i � <br /> j Prolecl Address(if kr.own) ' <br /> Attach fou�(4)copies of plans for proposed work- Draw to scale and note the following as applica6le: � <br /> • Property Lines • Centerline ol slreet � <br /> • Outline and dimensions ot all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All cells for Inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construclion <br /> Standards and Speciltcatlons. <br /> 3.Call Location Undarground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424�5555. � <br /> ��lBLiL CvO�C,�S f�ir�/T �r .P�'ICL.CE�.d / /�'� O <br /> C-?�,�,CJ � <br /> O <br /> a <br /> ACKNOWLEDGEAIENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and Save harm- <br /> less ihe Gty ol Evere�t irom any and all claims lor tlamages, cosls. <br /> expenses, or causes ol action that may arise because ol installation <br /> and maintenance ol �he improvemenl or other righl�ol-way use here�o <br /> applied br and further agrees to remove same upon notice Irom the <br /> Approved for Construction Date City and to repl�ce public property damaged thereby. <br />