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I <br /> � -- �_s� <br /> � <br /> D� h _17[:.4� Publm Wo�ks Permil• <br /> �r�l Q. <br /> Blag.Dept+ <br /> Application For <br /> PUBLIC WORKS PERMIT PUOToIaIFoaFee s — <br /> I.ass AppL Foe PviO s <br /> ea�ance oue s ���� <br /> Print or Type Only <br /> �,.r^;� ►; �r,�,;n�� a�� i ��51��� �r�r �2a i �.59-aygy <br /> Owner Mailing Address City Z�p Phone <br /> 5� Mailmg Address City Zip Phone <br /> Appticant <br /> Describe Proposed Work <br /> W <br /> Project Address(if known) �� � � ���� � -- � <br /> Atlach tour(4)copies ot plans for proposed work• Draw to scaie and note the fol�owing as applicable: � <br /> • Property Lines . • Centerline of straet � <br /> � Oulline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls tor inspection shell be made 24 hrs.in advance- phone 259•8815. � <br /> 2. All work shell be perfarmed in accordance with this permit and current City of Everett Design and Construction <br /> Slandards and Specilicetions. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> f <br /> , �ii�!'� SE�E� /�'�'T�'.«qC fii-� �Pr a�vi,c�EV O <br /> df. �'E �'�mai,,�� Cc�vE <br /> � <br /> � <br /> O <br /> ; <br /> a <br /> ACKNOWLEDGEMENT OF CO�DITIONS <br /> �.� The undersigned owner/applicant hereby agree�to ho�d and save harm- <br /> less the City o1 Everett from any and all clai:ns for damages, costS <br /> `--'`i ' '��{�`— ,// exPenses, or causes ol action that maY ari::o 6ecause ot installation <br /> ��� and maintenance of lhe improvement or other right-of-way use hereto <br /> !�'i J 2 87 <br /> � rri.� applied fo nd tuMher agrees to remove same upon notice from the <br /> Approved for Constru ion /' �a�e City and t� place puhlic properly damaged thereby. <br /> �---'--] .i � i <br /> -���- �/- 3 � /'''��/ � <br /> ��� . <br /> FINAL INSPECTION Date '�"� <br /> Approved as Constructed Sig�a ant <br /> everett PUBLIC WORKS DEPARTMENT WORK ZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Streel BE DILIGENTLY PURSUED TO COMPLETION. TH�S PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259•8815 pRJJECT OVER 90 DAYS DURATION. <br />