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Date—��/"� • • <br /> PuEli:Works Per i� <br /> Application For eia9.o�ai.+ �2��� <br /> PUBLiC WORKS PERMIT Publ.cWorksFee <br /> -a�a�Fa� s <br /> Less Foa�Fee 7aid $ <br /> BalancoDoe S <br /> Print or Type Only <br /> ��.�-�. ����.�rv�. /v�� �<lE. � �3�,3 -3 Ss„�. <br /> `Dwner MailingAddress City Zip Phone <br /> Applicant Mailing Address City Zip Phone <br /> Descri6e Proposed Work \ �—c�'� .�-C��C_i't�cLl ` /1�...7'c�+-v� <br /> W <br /> Project Address(if known) � <br /> Attach four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines � Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structu�es on the lol • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE / <br /> PERMIT CONDITIONS F,� <br /> 1. All calls for inspection shall be made 24 hrs. in advance• phone 259•881 5. ,� <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specilicalions. <br /> 3. Call�ocation Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> �`/�� �l'��='t-i��. /''✓n.C'.�s' f F,PiN.T if�E�j u�i�'EG' O <br /> �� ��8/8s � <br /> � <br /> � <br /> � <br /> a <br /> ACICNOWLE�GEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City ol Everett Irom any and all claims for damages, costs, <br /> expenses, or causes of action Ihat may arise becau�e ol instal�ation <br /> and maiNenance ot the improvement or other right-ohway use hereto <br /> applied for and furlher agrees to remove same upon nolice from the <br /> Approved for Consiruction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Conslructed Signature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WCRK AUTHORIZED BY TH�S PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Street 780 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: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />