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Date_�� / [� Pu011cWo�kaPaim �/J�� � <br /> : �-- <br /> Application For eiae�ono�.� <br /> PUBLIC WORKS PERMIT P�o°<Wo,k=Fea <br /> Totnl Fee s <br /> Less ADOL Fee PaiO S <br /> Print or Type Only ea�a��ao�e S �` <br /> Lc��u'� �,i�a� �.�lJ I 1'�', �� � �'i�i� �B�DI �-�7�/ <br /> Owner Mailing Address City Zip Phone <br /> �a't��n,��l�- IU.v�/ ��C !.cmn/��rr� ���/�ss <br /> Applican�L/ Mailing Addre�s� ity Zip Phone <br /> Describe Proposed Work c l����r1�C _ <br /> Prolect Address(il known) � / � � <br /> � <br /> Attach four(4)copies of plans tor proposed work- Draw!o scale and note the lollowing as a�plicable: � <br /> � Property Lines • i.enterline of street � <br /> � Outline and dimensions of all existing and • Indicate Norih <br /> proposed structures on Ihe lot • Show any proposed grading changes <br /> • Existing antl proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All cails for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shell be performed in ac. rdance with this permit and current City ol Everett Design and Construction <br /> Stendards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> C ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold nnd save harm� <br /> less ihe Cily of Evere�� from any and all claims for dF�inages, costs. <br /> expenses, or causes of aclion that inay arise because ct installation <br /> rJ �, �_31 _� and maintenance of lhe improvement or other right�oFway us� herero <br /> � applied tor and turther agrees to remove same upon notice fiom ihe <br /> Approved for Co �(ction Date Ciry and to replace public properry damaged thereby. . <br /> .�/�� 3-/� ��/ � / <br /> FINAL �NSPECTION Dale �"1��0, 96 <br /> Approved as Consiructed Signature of Applicant Date <br /> everett PUBLIC WORKSDEPAHTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTEO WITHIN <br /> � 3200CederStreet 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br /> Phone:259-8810 CANCELLED BY THE CITY UPON ANY STQPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />