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Date_��f�J Public Wo�ks Parmlt s U J ^ L�� <br /> BICg.Depl.t <br /> Application For <br /> PUBLIC WORKS PEI�MIT PUOTOI1FeeFea s <br /> Lesa ADo�Fee Peia S Jj� <br /> Balance Uua S �O`�� <br /> Print or'fype Only <br /> .l�1G� � /O✓E�l�-� .���� �o.< �v:c Tive..�f1 /,Q.'t C ` L S f ���� <br /> pW1e� Mailing Address City Zip Phone <br /> Appiicant Mailing Address City Zip Phone � <br /> Describe Proposed Work � <br /> W y � <br /> � � <br /> .�s�� -•u �J � � <br /> prolact Address(if known) ❑ <br /> � m <br /> Attach four(4)copies of plans for proposed work•Draw!�scale and note the lollowing as applicable: � y <br /> • Property Lines • Cemerline of street O <br /> • Outline and dimensions of all existing and • Indicate North y <br /> p�oposed structures on the Iot 0 Show any proposed grading chenges T <br /> • Existing and proposed utilities • Show measurements M � z <br /> DO NOT WRITE BELOW THIS LINE W � � <br /> PERMIT CONDITIONS O y <br /> 1. AII calls for inspection shell be made 24 hrs in advance• phone 259•881 5. <br /> 2. All work shell be performed in accordance with this permit and current City of Everett Design and Construction � "� <br /> Standards and Specificetions � <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•555�. � �,,.� <br /> � <br /> O � <br /> � • � <br /> � � <br /> O � <br /> a � <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and savc harm- <br /> less the City ol Everett irom any and all claims lor damages, costs, <br /> � /J / ex��enses, or causes of action that may arise because o1 installation <br /> �-i�nl�Y'" � /�� // ri/�J` antl maintenance of the improvemenl or other righl-of-way use here�o <br /> applied for and furiher agrees to remove same upon notice irom Ihe <br /> Approved for Con ctio� � a�e City and to replace public property damaged thereby. <br /> � // ��� �J/ <br /> AL INSPEC710N Date �� /��� " � �A� — <br /> Approved as Conshucted SI re f Appiicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFT[R IS TO <br /> � 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT P.fAY BE <br /> Everett,WA 98207 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259•8815 PROJECT OVER 90 DAl'S DURATION. <br />