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1 <br /> ; <br /> 1 <br /> �-�r'-�3 � x <br /> Date Vubl¢Works Pa�mil• "� � <br /> BICB-DcO��• ���� <br /> Application For <br /> PUBLIC WORKS PERMIT PublicWoiASFea �b �_— <br /> T��o�Foo s d, <br /> �oss Appl Fco PeIE S ?�� �7 <br /> BalencaDuo $ ^ � •— , <br /> Print or Type Only ; ��•�� — <br /> � � �, , - .;� � lt� �� ��- �7�'y 7y� /7�� <br /> r <br /> wner Mailing Address City Zip Phone <br /> �.�L��- <br /> Applicant Mailing Address City Zip Phone <br /> /, ''� <br /> Describe Proposed Work ` L�} ��«� �/N C�t-� (J ���/�L� /CL=�I���rJ<� <br /> - W � <br /> Prajecl Address(if known) � � �� �e' H <br /> .�ttach four(4)copies ol plans for proposed work• Draw to scale and note the tollowing as applicable: � <br /> • Property Lines • Centerline ot street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show ami pr000sed grading changes <br /> • Existing and proposed utilities • Show measurements /y� <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMI'i CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advanca-plione 259-8E�1 5. � <br /> 2. All work shall be perlormed in accordance with this permit and current Cit;�of Everett Design and Construclion <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <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 ol Everelt trom any and all claims for damages, costs, <br /> expenses, or causes of aclion lhal may arise because of installation <br /> ��j_ d� and maintenance of ihe improvement or other right-of•way use hereto <br /> applie r and lurther agrees to remove same upon nolice from the <br /> ove or o struc n Date City a to replace publi perty damage thereby. 1 <br /> ,_ . ; . �S� � / J <br /> FINAL NSPEC ION pa�e �/IZ� . �X� <br /> Approved as Constructed Signature ol Applicant Dale <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZ"D BY THIS PFRMIT MUST BE STARTEU WITHI� <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everel! WA 98207 CANCELLED BY THE GI7Y UPON ANY STOPPAGE OF WORh ON THIS <br /> Phone: 259-BB75 PROJECT OVEfi 90 DAYS DURATION. � <br /> R� <br />