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DatG5�2_��� Publit Work4 P it s O v—� <br /> ( <br /> Applicatlon For eiec�oen�.• � <br /> PUBLIC WORKS PERMIT PubhcWorksrea � <br /> Talel Fea s <br /> Less Aoo�Fee PaiE S_� <br /> Balance Oua S Z��� I <br /> Print or Type Only �3�57 <br /> i <br /> / . i <br /> W ' <br />� ner Mailing Address City Zip Phone I <br /> � ��� ���� 9 �� �' 36 _ G� Y 1 <br />�I Applicent Mailing Address City 2ip Phone � <br /> Desc��be Proposed Work � I <br /> i <br /> i <br /> W <br /> Project Address(if known) � <br /> Attach tour(4)copies of plans for proposed work- Draw to scaie and note the following as applicable� � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all ezisting and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and propo�ed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. Atl calls for inspection shall be made 24 hrs in advance-phone 259•881 5. � <br /> 2. All work shall be periormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Cail Locetion Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> 7. OvE,eH�s�vFr �iZ P�'n�`"'PSE� Gf�.�'iJ« CP,tiNOT O <br /> /�.t'O..iECT v✓E,� ALGE� .c'�/!�- OF- li✓il�,/ <br /> / � <br /> � <br /> � <br /> O <br /> a <br /> O� ACKNOVJLEDGEMENT OF CONDITIONS � <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> le�s the City ot Evereft trom any and all claims tor dameges, costs, <br /> axpenses, or causes ol action lhat may arise because ol installalion <br /> �� j�?��� a��y �G and mainlenance o fhe improvement or other right-ol-way use hereto <br /> y� applied br a d f iher agr os 16 rer�6 e upon�Uti�e irom the <br /> Approvetl lor Construction Date City and to (ila e public ro erty d ed thereby. � <br /> �� � �� � 7 l'/ G �� ' ����� � � <br /> i- s-f � � <br /> FI N ECTION Date <br /> Approved as Constructed Si ature ot Applican Date <br /> everett PUBLIC WORKS DEPAR7MENT ORK AUThIORIZED BY THIS PEFMIT MUS7 BE STAR7ED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGEN7LY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone: 259•8815 CANCEILED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER SO D�VS DURATION. - <br />