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Date�_IJ—d'B PuUiic Woixs Pc�mil• <br /> Application For ema oeo�.•�F�l�y�� <br /> PUBLIC WORKS PERMIT P��I¢Wo�bFea <br /> .o�r�F�o s <br /> �essAoo� FecPaiJ S <br /> Balance Due S <br /> Print or Type Only <br /> I3nI7 � d P fs'IYPQ'f I� �'Zq Rucl�e r f1✓� 9� zr / zs 2-- 6.5� <br /> Owner Mailing Address Clty Zip Phone <br /> Su N+.e <br /> Applicant Mailing Address Gty Zip Phune <br /> Describe Proposed Work _����1__f�.._j r �(�ro�� �w d r P�P�� OCl� <br /> v / <br /> ProiectAddress�ifknown) �Z� Gra.�d �✓Q. � <br /> � <br /> Attach four(4)copies ot plans lor proposed work• Draw to scale and nole the lollowing as applicable: � <br /> • Property Lines • Centerline ot streel � <br /> • Outline and dimensidns of ail existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and prOposed utilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMITCONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8870. � <br /> 2.All work shail be pertormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards end SFecifications. <br /> 3.Call Localion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> 11C:T I��j�C �I ti�.� ��/ $ � <br /> � � H <br /> ��� � <br /> O <br /> a <br /> 4CKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby ag�ees m hold and save harm- <br /> less the City ol Everett Irom any and a0 claims for damages, cosls. <br /> expenses, or causes ol action that may arise oecause of installalion <br /> and maintenance ol lhe improvement or o�her righ�•ol•way use hereto <br /> applied lor anA further agrees to remove same upon notice Irom the <br /> Approved for Consiruction Date Cily and to replace public property damaged Ihereby. <br /> FINAL �NSPECTION Date <br /> Approved as Constructed Signature ol Applicant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTI10RI7ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />