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i <br /> I-�z-B� ' <br /> D'a�Q . Pu�bcWorksPeimit�� ��� <br /> Applicatlon For ema.oea�.• <br /> PUBLIC WORKS PERMIT PublicWorksFae <br /> io1a1 Fee S <br /> less Appl.Fee Pai� s <br /> Print or Type Only sa�A��ao�, S <br /> Pr�.u,� � 7r�:;�/�d ir�i �/Q 2 /_�r�✓� �ul 9'�zo�� 3.37 Sa�' <br /> Owner � Mailing.Address City Zip Phone <br /> o„���Sn�K�� ro .��_ /�-� ��a� S���c�na�rl�. qsra9� �.��-��— <br /> Applica Mailing Addre s Ci�y 2ip Phone <br /> Describe Proposed Work ����L S�.�tn// �yi.u��OS�(�/� l C�� 1 <br /> 1�.(��� C1Cy.� .c� .o e r`�q� c �,K ! �j <br /> / W � <br /> � <br /> Prolect Address lif known) ���w ���/N � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the foilowing as applicable: � <br /> • Property Lines • Centerline ol slreet � <br /> • Outline and dimensions o!all existing and • Indicate Norih <br /> proposed structures on the lol • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All cells for inspection shall be mede 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be performed in accordance with ihis permit and current City ol Everett Design and Construction <br /> Standerds and Specifications. <br /> 3.Call Locetion Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> �UB��� c�o�e�s �.�rn�T,clar .�'�-�`,�,e�o O <br /> /- /2- ' U � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT 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 lor damages, costs, <br /> expenses. or causes of action that may arise G�cause of installation <br /> and maintenance ol the improvement or othP: righbo4way usc hereto <br /> applied lor a�d lurther agrees lo remove same upon notice Irom the <br /> App;oved lor Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date . <br /> Approved as Constructed Signature ol Applicanl Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZEO BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WH 98201 BE DILIGENTLV PURSUED TO COMPLETION. 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 />