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Date.� � � PUEOt"'arkcPermite _ <br /> Q � �, / <br /> Application For BIE9.Deo�.• <br /> PUBLIC WORKS PERMIT PUEIicWarksFee <br /> Totel Fee s <br /> Leas AD01.Fee PaiE S <br /> Print or Type Only aa�a��a o�a s <br /> ��lx'rt-. Is1� ��� i�n I?x�X ?���, 11"�.�i l i�n ���a:�� >>�'�-�11�r� <br /> Owner � Mailing Address City 2ip Phone <br /> ,��11��= <br /> ApplicaM Mailing Address City Zip Phone I <br /> 1- � <br /> Describe Proposed Work �7 �� `�l\1� J-���� ll-���( :��C .�� [��-� �1 �� } <br /> W <br /> Project Address(il known) � ' � - � � � <br /> Attach four(4)copies of plans for proposed work• Draw to scale and note the following as applicable: � � <br /> • Property Lines • Centerline of street � . <br /> • Oulline and dimensions of all existinq and • Indicete North <br /> proDosed atructures on the lot • Show any proposed grading changes , <br /> • Ezisting and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. Alt calls for inapection shall be made 24 hrs. in advance-phone 259-8815. � <br /> 2. All work shell be peAormed in accordance with this permit and current City o(Everett Design and Construction <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> �.�G llUor,���,'c��..�'��it���� 7 Zz -8� � <br /> � <br /> � . <br /> O <br /> a . <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> � less the City of Everett irom any and all claims for damages, costs, <br /> expenses, or causes of action ihat may arise because ot installation <br /> and maintenance of the improvement or other righFof-way use hereto <br /> applied for ard lurther agrees to remove same upon notice irom the <br /> Approved for Consiruction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Appmved ae ConsiruUed Signature of ApplicaM Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WI7HIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEIiEAFTER IS TO <br /> Evere�t, WA 98201 BE D�LIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY TtiE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 30 DAYS DURATIOIJ. <br />