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_- .--, <br /> �'-I�—�[� Pu�lm 1Va�Ms Pe�nu�h�� <br /> Date � ' <br /> BIOp Ueo�.+ <br /> Application For <br /> PUBLIC WORKS PERMIT `°°TowFaeFOe s <br /> Less AOP�Fee Pa�a S <br /> Baiance Due S <br /> Print or Type Only <br /> �� I Y. l I '� 1 a� � ( �'�7�91'U �Llnl�'� ���y-�(� � ,'���� -�� 7� <br /> Owner Mailing Address Cdy Lp Phone <br /> �y��� Phone <br /> Applicant Mailing Address ���Y Z'p <br /> DescribePropoSedWork �Y/ �'`--' �wf—` `�� <br /> W <br /> Prolect Atldress(il known) I � � <br /> Attach four�4)copies of plans for proposed work• Draw to scale and note the fotlowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicale Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities � Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O � <br /> PERMIT CONDITIONS � <br /> 1.AI�calls for Inspectlon shall be mede 24 hrs.in advance•phone 259•881 O. � � <br /> 2.All work shall be performed in eccordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 4B hrs.betore you dig.TOLL FREE NUMBER 1•800-424•5555. � j <br /> � (��U�� � `-�' . `f�����`3 � <br /> � O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City of Everett Irom any and all claims for dameges, costa <br /> expenses, or causes of action that may arise because of instal�ation <br /> and maintenance ol the improvement or olher right-of-way use hereto <br /> applied lor and further agrees to remove same upon notice irom the <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION �a�e Date <br /> Approved as Constructed Signature ol ApPlicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMEN7 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett WA 98207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br /> 1' <br />