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Date��� • • PUCIicWorkePermi�i �� <br /> �� <br /> ' Application For BIOg.Dcol.• [� <br /> RUBLIC WORKS PERMIT PVeTallFeeFee s <br /> Less Appl Fee PaiU S <br /> BalanceDue S <br /> Print or Type Only <br /> '�7� 1��.,��� L 2� �e. / 0 0 � ��7�,n-� ����" �S%-i 561 y <br /> �� Owner Mailing Address Cdy Zip Phone <br /> �J��J <br /> Applicant Mailing Address City Zip phone <br /> Describe Proposed Work �-���-�� r 'C"a'l-� <br /> W <br /> Prolect Address(if known) � � � ������� � <br /> Attach four(4)copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Properry Lines • Cente�line of street � <br /> • Outline and dimensions ot all er.isting and • Indica!e North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Sho�. measurements M <br /> W <br /> DO NOT WRITE BELOW THIS IINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs.in advance- phone 259•881 5. � <br /> 2. All work shall be performed in accurdance with ihis permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service AB hrs.before you dig.TOLL FREE NUMBER 1•S00•424•5555. � <br /> �1� ��`�BG/C GW,�',�S ������ ��rJU%�/', O <br /> � � ����< �- <br /> J � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant here6y agrees to hold and save harm- <br /> less the City ot Everett irom any and all cleims tor damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> and mainlenance of the impwvement or olher righFobway use hereto <br /> applied lur and further agrees to remove same upon notice irom the <br /> Approved for Construction �a�e Ciry and to replace public property damaged thereby. <br /> FINAL INSPECTION Uate <br /> Approved as Constructed Signature of Applicant Dare <br /> everett PUBLIC WORKS DEPARTMENT �^10RK AUTHORIZED BY THIS PERM�T MUST BE STARTED WITHIN <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Slreet BE DIL�GENTLY PURSUED TO COMPLETIC�N. THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPCN ANY STOPPAGF OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 DAYS DURATION. <br />