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Date�� !� i�� � P�o�,�wa�wsv�, <br /> , + <br /> Diag Oeo��' <br /> Applicalion For <br /> PUBLIC WORKS PERMIT Pu�To�fee��� S <br /> Less ApP�-Fec Paitl $ <br /> Baiance Uue S <br /> Print or Type Only <br /> mQ.r��ri� C� Po ,�X io� r��v�ll� g�a�o ����6/ <br /> —��"- MailingAddress City iP Phone <br /> Owner <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work �'� � ` ��, r'�� � <br /> V <br /> y� W <br /> Project Address lif known) �1/ /\� � <br /> Atlxch four I i) copies of plans for proposed work- D:aw to scale and note ihe followin9 as applicable: � <br /> • Properry Lines • Centerline ol street � <br /> • Ouiline and dimensions of all existing and • Indlcale North <br /> proposed structures on the lol • Show any proposed grading changes <br /> • Exisling and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-plione 259•8810. � <br /> 2.All work shell be performed in accordance with this permit a�d current City of Everett Design and Construction <br /> Standarrls and SpeciFications. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•80fi-$24•5555. � <br /> � �� �� ���'ut �� ��� <br /> O <br /> �'���''��/ ,� ��,�', F- <br /> G���a -Po � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hcreby agrees to hold and save harm� <br /> less lhe City ot Everett irom any and�all claims lor damages, cosis. <br /> expenses, or causes ol aclion that may arise because of installation <br /> and maintenance ot �he improvement or other ri�ht-obway use herelo <br /> �pplied tor and fuither agrees to remove same upon nolice Irom ihe <br /> Approved for Construction Date ��ty and to replace public proueriy damayed Ihereby. <br /> FINAL INSPECTION �a�e Date <br /> Approved as Constructeti Signature of Applicant <br /> WORK AUTHORIZED BY THIS PER�11T MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 180 DAYS OF Dl.TE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreel gE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Evere�t.WA98201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:253-8810 PROJECT OVER 90 DAYS DURATION. <br />