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Date�Ll—�'$ P�o��wo,�sP��m,�. —_p'� <br /> Application For em9 oea�..��l/7=1�� <br /> PUBLIC WORKS PERMIT P°°°°W°��°Fe° <br /> iotal Fee s <br /> Lev POCI.Fee Pm0 S <br /> B.11ance�ue .S <br /> Print or Type Only <br /> �I� � JPfS�'fPQ'�' F� ��Z� Ru�I�Fr >9✓� 9k` zd / z5Z- 65� <br /> Owner Mailing Address City up Phone <br /> Su��.e <br /> Applicant Mailing Address Cdy Zip Phone <br /> Describe Proposed Work _��a�I r S�r�C�� ri(�I� r Q11(PA / f�IOC/' <br /> ProjectAddress�ifknown) �22� l}rArt� �✓Q.. � <br /> � <br /> Attach four(4) copies of plans lor proposed work- Draw to scale and note the following as applicable: � <br /> � Property Lines • Centerline of street � <br /> • Outline and dimensions ot all exi;tiri�and • Indicate North <br /> proposed structures on th�a lot • Show any proposed yrading changes <br /> • Ezisting and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PEFMITCON�ITIONS O <br /> 1.All calls 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 Construction <br /> Standa�ds and Specifications. <br /> 3.Call Location Undergrounc Fervice 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> � � <br /> �C:�T -I� -�� ��ti�-� ��,/g <br /> , � I-- <br /> c,��� � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDI710NS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the Cily ol Everett Irom any and all claims lor damages, costs, <br /> ezpenses. or causes ol aclion �hat inay arise because of installation <br /> and maintenance ol ihe improvement or olher righ�-ol-way use hereto <br /> applied lor and fuither agrees to remove same upon notice Irom the <br /> Approved lor Construc�ion Date City and to repl.�ce public property damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Construded Signature ol Applicant Dale <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUS? BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DAIE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � Everett,WA9B201 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 />