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i <br /> Date��g� Pu�Lc 1Yorks Pamit• - l9 l" <br /> Application Por BItlB�Dept• �� <br /> PUBLIC WORKS PERMIT PUOiotoFvoFeo g <br /> Less AOPI.Fee Paio $ <br /> Balence Oue $ <br /> Print or Type Only <br /> � 11�����--t����`7n�P�r't�l �rl�.�'r�' 2.�1-�J�l�,. <br /> Owner Mailing Address Ci y Zip Phone <br /> ��1�1C]��I�_?�'7G1� � s. �1 �. -�t'� 25�- �5�� <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work ��� r� /��—�-� !.�i_/�l �� <br /> W <br /> Pro�ect Address(if known) � <br /> Attech lour(4)copies of plans for proposed work- Draw to scale and note the foilowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> � Outline and dimensions of all existing and • Indicate North <br /> proposed structures on ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 7. All cells for inspection shall be made 24 hrs. in advance- phone 259•8815. � <br /> 2. All work shall be peAormed in accordence with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> I�Y�T ►2�c�j� //-�z 8r O <br /> ��� <br /> � <br /> � <br /> 0 <br /> a <br /> ACKNOWIEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everetl from any and all claims for damages, costa <br /> expenses, or causes ol action that may arise because ot installation <br /> and maintenance of the improvement or other righFof-way use hereto <br /> Approved for Construction Date applied for and turther agrees to remove same upon notice irom ihe <br /> Ciry and to repl.�ce public property damaged Ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Sic�nature ot Applicant Date <br /> everett PUBLIC WOFKS DEPARTMENT WORK AU7HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Sireet 180 DAYS OF DATE PERMIT IS ISSUFD AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY VPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURIITION. <br />