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Date_���yC�S�.S1U � * � Vu�6cWoiksPermnttt���. /// <br /> / BIOD.OeP1.s��� <br /> Application For <br /> PUBLIC WORKS PERMIT Pu�licWo�ksFeo <br /> Tofal Fee s <br /> Lc55 Appl Fco Paitl $__ <br /> Print or Type Only ea�a��ao�� s <br /> LPn'�a �PrnPfl, ,. 1�27Y)'�A•,�o EvP�P1�- 9cF Dl 2.5�'— / 7(p2 <br /> Owner Maihng Address7 Gty Zip Phone <br /> Sow� e <br /> � Applicai�t Mailing Address Ciry Zip Phone <br /> Describe Proposed Ivork ��i 7� �y� �� r p ��cJp.��v _ <br /> Project Address(if known) 3a � <br /> � Attach fow(4) copies of plans for proposed work- Draw to scale and note the lollowing as applicable: � <br /> ' • Property Lines • Centerline oi street <br /> • Outline and dimensions of all existing and • �ndicate North �• <br /> proposed siructures on ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenls � <br /> DO NOT N'RITE BELOW THIS LINE <br /> PERMITCONDITIONS O <br /> 1.A�I calls lor inspection shall be made 24 hrs.in advance•phone 259-8810. � <br /> 2.All work shall be pedormed in accordance with this permit and current Ciry o1 Everett Design and Construction <br /> . Standards and Specifications. <br /> 3.Call Location Undergrour,d Service 48 hrs.belore you dig.70LL FREE NUMBER 1•500-424-5555. � <br /> O <br /> �.��� 1���-�����r'.�����o � <br /> ��8e � <br /> 0 <br /> a <br /> ACKNOWL[OGE��IENT OF CONDITIONS <br /> Tne undersigned owner/applicant hereby agrees�o hold and save harm- <br /> less Ihe City ol Everett Irom any and �II claims (or damages, costs, <br /> expenses, or causes of action th.it may arise because ol insta!lation <br /> and maintenance ol the improvement or other ri9ht-ol�way use hereto <br /> applied lor and turthe� agrees to remove same upon notice Irom Ihe <br /> Approved lor Consinictlon Date City and to replace public property Jamaged thereby. <br /> FINAL INSPECTION Dale <br /> Appreved as Constructed Signatwe of Applicant Date <br /> everett PUBLICWORKSDi�PARTMENT WORK AUTI�IORIZC-D BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 1B� DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everelt,WA 98201 BE �ILIGENT�Y PURSUED 70 COMPLETION. THIS PERMIT MAY BE <br /> Phone:259-8810 CANGELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />