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�. <br /> i oa►e�� � _ <br /> PuDlit Works Permlt• <br /> ' Application For Biay.Dep�.a �� <br /> ' PUBLIC WORKS PERMIT <br /> Puplk Wmks Fee <br /> ' TolalFea S� <br /> Print or Type Only TO POSTING Y� Le'aAoo�FeePeiG S <br /> Belence Ove s�p� <br /> —/ ��ry Ab[�a/fd- IMn�lol Za/�.> >4.� lcjZn �2 3 D.� n�, r-. ,.� 44- ZS 2 � <br /> � uwne� MaiNng Address City � Zi ZG'1 <br /> C P Phone <br /> �.t� � <br /> � Applicant Mailing Address ���Y <br /> Z�P Phone <br /> Describe Proposed Work � <br /> t � <br /> � Project Addiess(if known) �' i � � W � <br /> j Attach four(4)copies ol plens tor proposed work- Draw to scale and note the following as applicabte: � <br /> j • Property Lines • Centerline of street � <br /> • Outline and dlmensions of all existing and � <br /> proposed structures on the lot • Indicate North <br /> ' • Existing and proposed utilitles • Show any proposed grading changes <br /> � • Show measu�ements <br /> ( DO NOT WRITE BELOW THIS LINE m <br /> i� PERMI7CONDITIONS O <br /> 1.All calls fo�inepection ahall be mede 24 hrs.in advance•phone 259-8810. <br /> 2.All work ahall be pertormed in accordance with this permlt and current City of Everett Design and Construction ' <br /> - Standards and Speci(icaticny. <br /> , 3.Call Locatipn Underground Servtce 48 hrs.betore you dig.TOLL FREE NUMBER 1-8(�0-4Q45555. <br /> � �. ��- �r�� /�s a!� � -���-8 � Z <br /> ` � O <br /> � <br /> H- <br /> � � <br /> � O <br /> a <br /> ' ACKNOWLEDGEMENT OF CONDITIONS <br /> . The undersigned owner/applicant hereby agrees to hold and save harm- <br /> � less th= C�ty ol Everett from any and ali claims for dameges, costs, <br /> , expenses, or causes of action that may arise because of installation <br /> - / � and mamtenance of the improvement or other righbof-way use hereto <br /> ; Ap ved lor C � u on DBfe apP�ied for and further agre to remove same upon notice Irom the <br /> . City ano to place p e�ty damaged thereby. <br /> � a,7 /f-Sd <br /> FINAL 1 ECTION Date <br /> Approved as Construqed <br /> ig ture ol Appl ca t Date <br /> everett PUBLIC WORKSOEPARTMENT RK AUTHORIZED BY iHIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet BO OAYS OF DATE PERMIi IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLEiION. 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 />