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�ate�'/ ' Publie Worke Perml�• <br /> �� � BIEp.paD��• <br /> Application For <br /> PUBLIC WORKS PERMIT PuobcworxeFee <br /> Tolel Fea s <br /> Lase Aop�Fea PaiE S <br /> Balenca Due s <br /> Print or Type Only , <br /> E�eretf- S�l,nn/ ,(�,3 �- y��iLi1rl12rf./�,�. �piPt-f 96'0�0/ 339-s�a�r.� <br /> Owner <br /> Mai4ing Address Cily Zip Phone <br /> / ,� �. ,�. F�� r�'aas d5�-���i <br /> F� H �Ad �C�ti/v d ti,, !d�a �p�„� � ZiP Phone <br /> Appiic nl Mailmg Address Ctty <br /> Describe Proposed Work <br /> W <br /> Project Address(il known) � <br /> � <br /> Attach four(4)copies of plens for proposed work• Draw to scaie and note the lollowing as applicable: � <br /> • ProoeAy Lines • Centerline ol street <br /> • Outlfne and dimensions of all existing and � Indicate North <br /> proposed siructures 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. AII calls for inspection shall be made 24 hra in advance-phone 259•881 5. � <br /> 2, All work shell be peAormed in accordance with this permit and current City ot Everett Design and Construction <br /> Standards and Specificetiona � <br /> - 3. Call Locetion Underground Service 48 hra before You dig.TOLL FREE NUMBER 1•800•424•5555. <br /> O <br /> ,,�o k� ,����-�� �� ~ <br /> � N <br /> ��/���/� o <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> l'he undersigned owneqapplicant hereby agrees to hold and save harm- <br /> � less Ihe City ol Everett irom any and all claims lor damages. costs, <br /> expenses, or causes of action that may arise because o� installation <br /> and maintenance of the iinprovement or other right-of�way use herelo <br /> applied for a�d luriher agrees to remove same upon notice Irom the <br /> � Appioved lor Construction Date Ciry and to replace Vublic property damaged Ihereby. <br /> FINAL INSPECTION Date Dale <br /> Approved as Constructed Signature of Applicant <br /> WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Streel BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT A1AY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />