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�� �"� <br /> �8te . PuEut Warka Permil ps� <br /> BIAO�DeO��� W /�� <br /> Application For <br /> PUBLIC WORKS PERMIT PUEIicWorksFee <br /> Tolel Fee S <br /> lees Aoo�Fea PeiE S <br /> Bal�nce0ue S , <br /> Print or Type Only <br /> PPr�� m ��o�si�i ���s�nRn� F�F�,e,�7 �Zoi �5�-'2633 <br /> � Owner MeiNngAddress ���Y Z�P woh� 3S(�^S7// <br /> 5,�rn E <br /> Applicant Mailing Address City Zip Phone <br /> DescriCe Proposed Work �S�'' �T (}�R�r��O�T QN .�y�S��� <br /> —�c�l v rr l,.. I <br /> W � <br /> ProjectAddress(ilknown) i8� KfS l��f � <br /> Attach tour(4)copies of plens for proposed work•Draw to scele and note the lollowing as applicable: � , <br /> � • Centerline of street � I <br /> • Property Lines � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes i <br /> � Existing und proposed utilities � • Show measurements M � <br /> W <br /> DO NOT WRITE BELOW THIS LINE O I <br /> �PEFMIT CONDITIONS <br /> 1. All calls lor inspection shall be made 24 hrs. in advance- phone 259•8815. � <br /> 2. All work shell be performed in accordance with this permit and wrrent City of Everett Design and Constructioo i <br /> Standarils and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL PREE NUMBER 7-800•424-5555. � � <br /> �`Uf3'<iC: L�'O�',fS f��'�s�i/ �1/07 /'��Ui,�'`•n �/3 E O � <br /> �� � � � <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 ot Everett Irom any and all claims for damages, costs, <br /> ezpenses, or causes of action that may arise because ol installation <br /> and maintenance ut the improvement or olher right-ol•way use hereto <br /> applied for and turther agrees lo remove same upon notice lrom the <br /> � Approved for Censtruction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date Date <br /> Approved as Construcled Signature of Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF OATE PERMIT IS ISSUED AND THEREAFTEFl IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 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 />