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Date��� � � ' ' <br /> PuoOc Wons Peimil e <br /> Applica��on For oieB�Deo�.+�� � 7 <br /> PUBLIC WORKS �PERMIT PublicWoM1�Fee <br /> Totel Fee s <br /> Less Appl Fee Paid S <br /> Print or Type Only BalenceDua S <br /> ��r� .�r,5r ��mh �.� ,-, rx���r r�t��3� G�� <br /> �w'ner Mailing Adtlress p�� - <br /> Y ZiP Phone <br /> y3all-C <br /> Appiicanl Mailing Address Cit <br /> Y ZiP Phone <br /> Describe Proposed Work ��,,,�� l��lp M <br /> _ � <br /> � <br /> - W ' <br /> i � � � � <br /> Pro�act Address�if known) � <br /> Atlach four(4)copies of plans for proposed work• Draw+o scale and note the following as appliceble: � <br /> • Property Lines • Centerlinr. �d street � <br /> • Outline and dimanslons o1 all existing and • Indicate North <br /> proposed structur<_a on the lot • Show any proposed grading changes � <br /> • Existing and propoaed utllities • Show measurements � � <br /> DO NOT WRI7E BELOW THIS LINE � <br /> PERMITCONDITIONS O � <br /> 1. AII cells for Inapection shall be made 24 hrs. in advance-phone 259•8815. � �, <br /> 2. All wark shall be performed in accordance with ihis permit and current City of Everett Deaign and Construciion <br /> StenAards and SpeciNcalions. <br /> 3. Cell Location Underground Service 48 hrs. before you dig.TOLL fREE NUMSER 1•800•424•$SSS. � , <br /> / .-Cf�. �-�/C77/z� ���J�.zt.�' o��t�l' � �L'. ..CKsN �8�a�1 O . <br /> � �� � <br /> � <br /> O <br /> a <br /> ACKNC�WLEDGEMEIJT OF GONDITIONS <br /> ihe undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Ciry of Everett Irom any and all claims for damages, costs, <br /> expenses, or causes o1 action that may arise because of installation <br /> and maintenance of the improvement or olher right-of-way use hereto <br /> Approved for Construction applied for and further agrees to remove same upon nctice lrom the <br /> Date City and to replace public property damaged thereby. <br /> PINAL INSPECTION Date <br /> Approved ac Construded Signature ol Apphcant Date <br /> evcrett PUBLIC WORKS DEPARTMENT � WORK AUTHORIZED BY TiiIS PEflM1T MUST BE STAR7ED WITHIN <br /> � 3200CedarStreet 1B0 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> EveretL Wq g8201 BE DILIGENTLY PURSUED TO COM.PLETION. THIS PERMIT MAY BE <br /> Phone: 259�8875 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />