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. <br /> / a� r.v�„� <br /> DB�Q(./�� � �7� � /_v` ,� PuGhe 1Vorka Perm�l• . � _ <br /> y v" <br /> Application For Biap oen��� <br /> PUBLIC WORKS PERMIT °°°,o,aF��F°e : z,.L— <br /> Less Roo�.Fee PeiO S� <br /> Balance Due S <br /> Print or Type Only <br /> a,6� J�.� �.�� �-�- �3 � 3 �r�k. l��� ��yZ�� 3ss-�nsc. <br /> Owner Mailing Address City Zip Phone <br /> Sz•�+�+ ' <br /> Applicant Mailing Address City Zip Phone - <br /> r <br /> 'c <br /> Describe Proposed Work �XGLv v� �Qvv '/ _ _ <br /> Project Add�ess(if known) �� Q �2�• '`— V�"" � � Z� � <br /> � <br /> Attach lour 14! copies of plans lor proposed work- Draw to scale and note Ihe tollowing as applicable: � <br /> � Property LineS • Centerline of streel � <br /> • Outiine and dimensions ol all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading chanyes <br /> � ErisHng and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t. All calis for inspection shal�be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be pertormed in acwrdance with this permit and current City of Everett Design and Construction <br /> Standards and Specificationa <br /> 3. Cell Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•S00•424•5555. � <br /> �. �.�- SE'PA uyt�.i�ia�s �`f`� <br /> � <br /> �: r.� s�,�t a.1 ��/y �� /.��► �f qi/ r,'.� � <br /> N <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees�o hold and save harm- <br /> less Ihe Ciry ol Everett Irom any and all claims 1or damages, costs, <br /> � expenses, or causes of action thal may arise because ol installation <br /> � �� antl maintenance of Ihe improvement or other right�of-way use hereto <br /> applied for and furiher agrees to remove same upon notice irom ihe <br /> Approved br Construction a�e City and to ace ublic property dama�ed thereby. <br /> / ,c�+�- �=1 r-�L � � �� <br /> FI��B4f1 ION Date � <br /> Approved ac ConslruCted Signature ol Applican Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED Y THIS PERMIT MUST BE STARTFD WITHIN <br /> 780 DAYS OF DATF PERMIT IS ISSUED ANO THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CI7Y UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8875 PROJECT OVER 90 DAYS DURA�iION. <br />