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"1 <br /> � 1 <br /> Date � � I � Pubilc Works Permit• � � " <br /> AppliCation For Bme.o�c�.+ <br /> PUBLIC WORKS PERMIT PUbTotelFeeFeo $�� � <br /> Lesa Appl Feo Paitl � � <br /> aa�e��oo�a s <br /> ao m ` <br /> Print or Type Only p3 �SS <br /> L fa1,:/Zr/�Cc /? /��nr.,',sr�i ! ( 31 1! I(-i> t.i�•.�� i-��r:ii� �� d '-� � i S L-') `15� <br /> Owner Mailing Address City Zip Phone <br /> �A f`T F <br /> Applicant Mailing Address City Zip Phone <br /> DescribeProposedWork �'��` �` � �"�/�S L FI~ �iL�F� � �l� 5 !.-AC.ti� i' <br /> W <br /> Prolect Address(if known) <br /> ��r--� ,- /a o.s � ���,,,F v,P w �� � <br /> Attach four(4�copies ot plans for proposed wo�k- Draw to scale and note lhe following as applicable: � <br /> • Property lines • CeMerline of street � <br /> • Outline and dimensions ol all existing and • Indicate Dlorlh <br /> proposed structures on the lot • Show any proposed c�rading changes <br /> • Existing and proposed utilitios • Show measurements /y� <br /> W <br /> DO :�OT WRITE BELOW THIS LINE O <br /> PERMITCONDITIONS <br /> 1. All calls tor inspeclion shall be made 24 hrs. in advance•phone 259•881 5. � <br /> 2. All work shall be perlormed in accordance with lhis permit and current City ol Everetl Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underc�round Service 48 hrs. belore you dic�.TOLL FREE NUMBER 1-800•424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersi9ned owner/applicant hereby agrees to hold and save harm• <br /> less lhe City of Everett Irom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of inslallation <br /> }_J�,f3 and maintenance o( the improvement or other right-oi-way use hereto <br /> applied lor and further agrees to remove same upon notice from the <br /> A lor ConsVuction �a�e City and to replace public property damaged ihereby. 1 <br /> ��t�� �=�G�3 .�� . / r <br /> FI NSPECTIpN Date ��l�I���/�� " ' �• � "� �� <br /> Approved as Consiructed Signalure ol Applicant Date <br /> everett PUBLIC WORKS DEF'ARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEfiEAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 pRO:ECT OVER 90 DAYS DURATION. , <br />