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; <br />' - <br /> Date_1S,:,eLC�� � <br /> a�orro wo�xs aa�mn, <br /> Application For eioy.oeoi.•—�?��� <br /> PUBLIC WORKS PERMIT PueTolaFeeFec § <br /> Less Apo�Fee Pa�C $ — <br /> Belence Duo S <br /> Print or Type Only � <br /> � <br /> i <br /> t�,�n��.►� r �,� _ i��. Di2. � �u �Y�v l c�q-���1 ' <br /> Owner Mai�ing Address City Zip Phone <br /> �Sl�4v�1P <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work ���1 ���!���/y) _ � <br /> W <br /> Prolect Address(if known) � <br /> Attach lour(4)copies of plans lor proposed work- Draw to scale and note the following as applicable: r <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing end • Indicate Norih <br /> proposed structures on the lot � Shov. any proposed grading changes <br /> • Existing and proposed utilities • Sho.+measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All cal�s for inspection shall be made 24 hrs. in advance•phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everetf Design and Construction <br /> Standards and Specifications. <br /> 3. Cell Location Underground Service 4B hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> rZc�� ►g��ui��� O <br /> ~J <br /> /�.�a-a� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold antl save harm• <br /> less the City ol Everclt irom any and all claims for damages, costs, <br /> expenses, or causes ot action that may arise because ot installation <br /> and maintenance ot the improvement or other right-oFway use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> Approved for Construc�ion Date City and to replace pu6lic property damaged ihereby. <br /> INAL INSPECTION Date <br /> �proved as Consiructed SignaWre of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PEFMIT MUST BE STARTED W�THIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED hND THEREAFTER IS TO <br /> Everett, WA 98201 BE DILIGENTLY PUF7SUED TO COMPLETION. THIS PERMIT MAY 8E <br /> CANGELLED BY THE CITY UPON ANY STOPPAGE OF W(�RK ON THIS <br /> Phone: 259•8815 PROJECT OVER 90 DAYS DURP.TION. –� <br />