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Date���i <br /> Publlc Worka Permil• <br /> Applicetion For eiea Den�.�___�rQ�/�.sa z <br /> PUBLIC WORKS PERMIT PuOTotelFaeFee s - <br /> . �eea poo�Fee ve�e S <br /> Print or Type Only ea�e��,o�a t <br /> r„"Ito-,,,n�.r k Cn�.,,,��i <br /> Owner MaiNng Address Cit <br /> Y Z�P Phone <br /> ��a�� �,ha d- A -7M � I�I�OS C��P/� �� Q,.O .�n���n.v L� p �on <br /> Applicant Mailing qddress City Zip� 3 phone n�� <br /> Describe Proposed Work . TI�n.FWi �(� �}.P ]�y ��� rf�Jla Is ����/ y /J�0 <br /> � <br /> Pioject Address(il known) � <br /> Attach four(4)copies ot plens for proposed work• Drew to scale a�d note the following as applicable: � <br /> • P�operty lines � <br /> � Centerline ot street � <br /> • Outline and dimensions of all existing and • Indicate NoAh <br /> proposed structures on Ihe lot • Show ariy proposed grading changes <br /> • Existing and proposed utilities � Show measurements <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•8815. <br /> 2. All work shall be pertormed in accordance with this permit antl current Ciry ol Everett Design and Construction ' <br /> Standards and Specificetions <br /> 3. Call Location Underground Srrvice 4B hrs. before you dig.TOLL FREE NUMBER 1•$p0•424•5S5S. <br /> � <br /> �UBL/G Lvo,C.f'.S' /�',2njiT it/OT �'F4��f..� O <br /> /�//Bb <br /> C=�� � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and ave harn�� <br /> less the City ol Eve�ett trom any and all claims for dama5�s, costs, <br /> expenses, or causes ol action that may arise because of ir�;tallation <br /> and maintenance of the improvement or other right-of•way u�e hereto <br /> Approved lor Consiruction applied for and further agrees to remove same upon notice Irom the <br /> Date Cily and to replace public property damaged thereby. <br /> FINAL ;NSPECTION Date <br /> Approved as Constructed Sulnalure of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMiT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA g8201 BE DILIGENTLY PURSUED TO COMPLET�ON. THIS PERMIT MAY BE <br /> Phone:259-9815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />