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Date�O O a�ei�c wo��s a � <br /> App�ication For eme oen�.• �— <br /> PUBLIC WORKS PERMIT PUOTOtAFeeFea S=� <br /> Less Appl.Foe Pai� ��7� <br /> Baiance0ue s r " _ — <br /> Print or Type Only <br /> ��� �n„►�i� P� ��x a��a� ���r�� ��ay a��-�16 <br /> Owner Maihng Address Gty Zip Phone <br /> ��a �1c� � i � ►���r� ��-f-�le. �819� ���-�`-� l� <br /> Applicant Mailing Address Cily Zip Phone <br /> Describe Proposed Work 11 (Y� �A C.l ( L���� /�( �' � <br /> , o <br /> W <br /> Prolect Address(if known) � �"� "�«� � H <br /> Attach four(4)copies ol plans lor proposed work• Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline ot street � <br /> • Outline and dimensions of all existing and • Indicate Noith <br /> proposed struClures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for Inapeclion shall be mede 24 hrs.in advence-phone 259•8810. � <br /> 2.All work shall be pertormed in accordance with this peimit and current City of Everett Uesign and Conslruction <br /> Standords and Specifications. <br /> 3.Call Location Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1•S00•424•5555. � <br /> � � a/�,�,.P��,�.� �-��-�� O <br /> // � <br /> � <br /> � <br /> a <br /> ArKNOWLEDGEMENT OF CONDITIONS <br /> The undersic�ned ownerlapplican�hereUy agrees to hold and save harm- <br /> Iess �he City of EvereQ Irom sny and all claims icr damages, cos�s. <br /> expenses, or causes ol action that may arise because of installation <br /> �O and maintenance ol lhe improvement or other righ4ol-way use hereto <br /> __/�j // applied br and turther agrees to remove same upon notice irom lhe <br /> Approved fo�tion '/���"` � Date City and to replace public property damaged thereby. <br /> `' � <br /> ��� �-� �S <br /> F�NAL�NS CTION ' Date <br /> Approved as Constructed ign fe of pplicant Date <br /> W K AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 780 DAYS OF DATE PERMI7 IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet 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�8810 PROJECT OVER 90 DAYS DURATION. <br /> � <br />