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,, ���'���� F> . ,—. --�— , <br /> . � a . � , , <br /> De�e�I / ' ' ' I PubliCWorksPe�miti/�� J� <br /> BIEq.UaGI.��._P� <br /> Application For � <br /> PU�LIC WORKS PERMIT Pu01i[WorbFee — <br /> Toul Fee s— <br /> � Leas AOP�fte P�1E S <br /> Balencn Due S <br /> Print or Type Only <br /> � - �� � �, <br /> � � MaiNng Address City Zip Phone <br /> .. �� /' /1 � � r '.� Oq.. � � �� � � .�`/�� <br /> t�'Q..1(.����C-�v^l'C�-o J � � .. . 1!_ <br /> Applicant Mailing Address � City 'ip Phone <br /> DescriAe ProPosee Wod, � + ` J�Zn��-) �� Cc�.S�, <br /> _�_ ��. <br /> Project Address(if known) __ ���� �� `�' ` ""�`�v �� � <br /> � <br /> Attnch four�4)copies of plans for proposed wo�'�• Dra�H to scale and note the fol�owing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and aimensions of all ex�sting and • Indicate North <br /> proposed sduc:uros on the lot • Show any proposed grading changes <br /> • Ezlsting and proposed utiiities • Sho�v measurements M <br /> W <br /> 00 NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls lur inspection shall be made 24 hrs. in advence- phone 259•8815. � <br /> 2, All work shall be pertormed i� accordance with this permit and current City ot Everett Design and Construction <br /> Stendarils and Specifications <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> /l.�"7 f�U.GL/G Ct�L'�i;fS f�c.�v�,�T �f�=:��c�rc'ED .:.i�.�'/A(� O <br /> `���/ � <br /> � <br /> O <br /> a <br /> ACKNCWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant here�y agrees to hold and save harm• <br /> less the City of Everett irom any anJ all claims for damages, costs. <br /> expenses, or causes ol action that may arise because of msta6ation <br /> and maio,enance of lhe improvemenl or other righPot-way ase herelo <br /> applied tor and lurther agrees to remove same upon notice from the <br /> Approved for Construclion . Uate Cily and to replace public property damaged thereby. <br /> FIIJAL INSPECTION Date Date <br /> Approved es Constructed SignaWrP of Applicant <br /> WORI: AUTHORIZED BY THIS PERM�T MUST BE STAHTED WiTHIN <br /> everett PUBIIC WORKS DEPARTMENT 1q0 DF.YS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street Bi: DILIGENTLY PURSUED TO COMPLETION. THIS PERMIi MAY BE <br /> Eve�ett,WA 98201 CA1�CELLED BY 7HE CITY UPON ANY S7GPPAGE OF WORK ON THIS <br /> �+ Phone: 259•8815 PRO��ECT OVER 90 DAYS DURATION. <br />