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Date��Q � , , r � PublmWorksPnrmit� __%� <br /> Application For aiea-oaoi.•�� <br /> PUBLIC WORKS PERMIT P°°°°W°,ksFe° <br /> Tala1 Feo S <br /> Lesf Appl Fea Pald S <br /> Print or Type Only e��e��a o�e s <br /> .� /� !1 asa 3yay <br /> y ` ��� ��� <br /> ��O�tP.la—v�,��YC�a /�lJ� !�n ,Fll� �'02�,'' �itJ � o2�P�t �(D <br /> wner �� - ailing Address City Zip Phone <br /> ��,iYlp <br /> Applicant Mailing Address City Zip phone <br /> Describe Proposed Work �g/,fl /Y( iLYI �,�.�Jh9�L' �� �_ (��,il����f.� <br /> W <br /> Project Address(if known) � <br /> Attach tour(4)copies of plans for proposed work• Draw lo scale and note the tollowing as applicable: � <br /> • Property Lines • Centerline ol street � <br /> � Out�ine and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CON�ITIONS O <br /> 1. All calls for inspection shall be made 24 hrs. in advance-phone 259•881 5. � <br /> 2. All�vork shall be perbrmed in accordance wilh this permit and current Ciry of Everett Design and Construction <br /> Standards and Specilications. <br /> 3. Call Localion Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> ��C� rG�li� ��c?r='.�S ��c��/hiT �EG�?v.�,2F� O <br /> _���/`��� H <br /> ��� � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersi�ned owner/applicanl hereby agrees to hold and save harm- <br /> less the Ciry of Everetl irom any and all claims lor damages. cosls, <br /> ezpen5e5, o� causes ol attion lhat may ari5e beCause of inslaltation <br /> and maintenance of the improvement ur other righFobway use hereto <br /> applied lor and further agrees lo remove same upon nolice I�oT ihe <br /> Approved tor Constru.tion Date City and to replace public property damaged ihereby. <br /> FINAL INSPEC710N Date <br /> Approved as Constructed Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AU7HORIZED BY THIS PERMIT MUST BE STAR7ED WITHIN <br /> � 3200CedarStrcet 1A0 DAYS OF DATE PEfiM1T IS ISSUED AND THEREAFTER IS 70 <br /> Everell. WA 98201 BE DILIGENTLY PURSUED TO COMPLE710N. THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITY UPON ANY 5TOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />