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Date.�i��=�7 ��r / l <br /> PubbcWorkSPermrt+ _ <br /> Application For eiae.oepi,+� <br /> PUBLIC WORKS PERMIT vubTo�FeaFoo 5 <br /> Less ano�.Fee Fnie $ <br /> BalancaDue g <br /> Print or Type Only <br /> �cl �nKjqd.fP/L .��i�-o"� G rrn /�!� ��/P/P �' /r� �}`(" �/ `'-..�0?/ 7 I <br /> Owner Mailing Address Ciry Zip one <br /> SQ h" � '� <br /> Applicant Mailing Address City Zip Phone � <br /> Describe Proposed Work �ri �� YI P' ) -�'Ib l/' � Pxl,1�T� Yldi 7D'f� � _ <br /> � <br /> = W <br /> Project Address(if known) pZa.� 02 ` �/n n � . <br /> Attach four(4)copies of plans lor proposed work• Draw lo scale and note ihe lollowiiig as applicable: � <br /> • Property Lines . • Centerline of street � <br /> • Outline end dimensions ot all existing and � Indicate North <br /> proposed structures on the lot • Show any proposed Q�ading changes <br /> • Existing and proposed utililies � Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shell be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shall be performed in accordance with Ihis permil and current Ciry ol Everett Design and Constru.,tion <br /> Standards and Specilicalionc <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBEH 1•800•424•5555. � <br /> ��L��f/G �.GIC�'�S f7r'/'/J'�jj ���i �lY� / ���/��/ O <br /> i(".. _� C //-_'C=.� <br /> _. /i <br /> �/ � � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/apphcanl hereby agrees to hold and save harm- <br /> less the City of Everett Irom any and all claims lor damac�es, costs, <br /> expenses, or causes of aclion that may arise because of installation <br /> and maintenance of lhe improvement or o�her righbol�way use nereto <br /> applied lor and fur�her ag�ees to remove same upon notice trom the <br /> Approved lor Construclion Date City and lo replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Si9nature of Applicant Date <br /> PUBLIC WORKS DEPARTMENT WORK AUTIIORIZED BY THIS PERMIT MUST BE STARTcD WITHIN <br /> everelt 180 DAYS OF DATE PEHt..IT IS ISSUED AND THEREAFTEf� IS TO <br /> � 3200 Cedar Street BE DILIGEN7LY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everetl,WA 98201 CANCELLEII BY THE CITY UPON ANY STJPPAGE OF WORK ON 7HIS <br /> Phone: 259�8815 PROJECT OVER 90 DAYS DURATION. <br />