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� • <br /> Date� J • r��ro woaa v n. <br /> � "�s' /s �� <br /> Application For BiCq DeW . <br /> PUBLIC WORKS PERM17 PubTot�FeeF� . <br /> Leae AoO�Fee Ve1E s — <br /> BalanceDue s <br /> Print or Type Only <br /> �� <br /> � �vi�E�cL ��o�TP 9/G- �pc��� � — <br /> Owner Mailing Address City Zip Phone <br /> '� o� r�.1�c�! /I�a �N �a ��n �� o7s5�o� �� <br /> pp�icant Mailing Address City Zip Phone <br /> Describe Propose rk <br /> ��AT- �l� � I��L 1 =-r ��^ - <br /> 't1 pi U�v G Y At3 __ <br /> ^ -_ W <br /> Project Address(if known) �" � C � <br /> AttaCh four(4) copies ot plans lor proposed work• Draw to scale and note lhe following as applicable: � <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimensions oi all eRisting and • Indicatc North <br /> proposed structures on the lot • Show any proposed graCing changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inepection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and curreM City oi Everett Oesign and Construction <br /> Standards and Specitications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> /J�O �/I�G/G /,I�O,Q,�S' f��'�/r��T �FG�U/.F'�-� O <br /> ��� ,�'-/P-6'-s' � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGENiENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City of Everett trom any and all claims for damages, costs, <br /> ezpenses, or causes of action Ihat may arise because of inslallation <br /> and maintenance of the improvement or o�her right-of�way use hereio <br /> applied lor and lurther agrees to remove same upon notice trom the <br /> Approved for Construdion Date City and to rep�acc public property damaged thereby. <br /> FINAI �NSPECTION Date -. <br /> Approved as Consiructed Signature ol Applicant Dale <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 780 DAYS OF DATE PERMIT IS ISSU�:U AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259•8815 PROJECT OVER 90 DAYS DURATION. <br />