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.., <br /> Date� Puoi¢Wods Pnrmii• <br /> Application For Biap.Deot• <br /> PUBLIC WORKS PERMIT �V�TolalFee`B8 = _ <br /> Less ApP�-Fee PeiE S <br /> BdITnCn,[lu! .S <br /> Print or Type Only <br /> Lee Bav1e �n/D E , G'�6nnF �✓ �nri� `��a � dSo� �9c�__ <br /> Owner MaJing Address Ciry Lp Phone <br /> U)P D� (���f- � 5��z � -/�f-3� .ly`- �J`aJ ��i��� ,��Q p,Qa�,Z— <br /> ApplicaM Mailing Address City Zip Phone <br /> Describe Proposetl Wurk ���y�_�� 11(,�„S`h.r.� I <br /> W <br /> � Project Address(if known) � � <br /> Attach four(4)copies of pians for proposed work• Draw lo scale and note the following as applicable: � <br /> • Property lines • Centerline ol street � <br /> • Outline and dimensions ot all existing and • Indicate North <br /> I proposed st�uctures on the lot • Show any proposed grading changes <br /> • Ezisting and proposed utilit�es • Show measurements <br /> � DO NOT�NRITE BELOW THIS LINE � <br /> 1 PERMITCONDITIONS O <br /> 7.All celle for inspection shail be made 24 hrs.in advance•phone 259•881 O. � <br /> 2.All wotk ahell be pertormed in accordance with this permit end current City ot Everett Design and Construction <br /> Standards and Specificatio��. <br /> 3.Cell Lxation Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �) / v�K�'i W�"'i''� /-��L .,�/�L /C—C��V,�V•- - -D O <br /> U ' / � <br /> �'-%/ �/�� N <br /> /-�a ya O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City ot Everetl irom any and all claims lor damages. costa <br /> ezpenses, or causes ol action that may arise because of installation <br /> and main�enance of the improvement or other right•ol•way use hereto <br /> applied for and lurther agrees to remove same upon notice irom the <br /> Approved for Construction Date City and to replace public property damagetl thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applican� Date <br /> everett PUBLICWORK;tOEPARTM£NT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED W�THIN <br /> � 3200CedarStre�t 780 DAYS OF DATE PEF7MIT IS ISSUED AND THEREAFTER IS TO <br /> Everet4 WA 982C�1 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BC- <br /> Phone:259�881i) CANCELLED BY THE CIl Y UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVEA 90 DAYS DURATION. <br />