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' _. <br /> �8te��(�� ' ' aueecWorxaPermn <br /> Application For <br /> oiaa.oeo�.• � <br /> PUBLIC WOFiKS PERMIT PublitWorkaFea <br /> To�e�Faa s <br /> Less RpD�Fea PaIU S <br /> Balrnce Due s <br /> Print or Type Only <br /> (.//�/j1�Cl�L �-� c ('-`,�1�''� �.L7".1�� ���`o'�:' l �-'�'.��� <br /> Owner MaiHng Address City Lp Phone <br /> k k <br /> Applicant Mailing Address Cily Ziv Phone <br /> Describe Proposed Work ( n���� `-� - <br /> W <br /> '`� I-Project Address lif known) <br /> Attach fom(4)copies of plans for proposed work• Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Eziating and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PEfiMIT CONDITIONS <br /> 1.All calls for Inspection shall be mede 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shell be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standarda end Specifications. <br /> 3.Call Locatlon Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800�424•5555. � <br /> O <br /> 1�10 t� � l�( ���� �� 2�� � <br /> ��,,,.Q�'�`��-. � <br /> .��z��� Oa <br /> ACI(NOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less �he City ol Everett 1rom any and all claims for damages, costa <br /> expenses, or causes ot action ihat may arise because of installation <br /> and maintenance of ihe improvement or other right•of-way use here�o <br /> applied for and further agrees to remove same upon notice Irom the <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed SignaWre of Applicant Date <br /> WORK AUTHOR�LED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMEN7 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PE{iM1T MAY BE <br /> Everett,WA 98201 CANCELLED BY THE GITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJECT OVER 90 DAYS DURATION. <br />