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i <br /> Date�D Puei�c Worts Permi <br /> Application For Bmg.Dep�.• �� <br /> PUBLIC WORKS PERMIT PubTolnlFeeFBe s <br /> Less non� fec Paie S <br /> BalanceDue S <br /> Print or Type Only <br /> �.���� `�}�� ��� <br /> Owner Madmg Addre;s City Zip Phone <br /> Appiicant Mailing hddress Ci'y Zip Phone <br /> Describe Proposed Work � r ����a���—���' <br /> W <br /> Project Addross 1if known) � <br /> Attach four(4) copies of plans for proposed worl:- Draw to scale and nole thr lollowing as applicable: � <br /> � Property Lines • Centerline of sireet � <br /> � Outline and dimensions ot all existing and • Indicate Norlh <br /> proposed structures on the lot • Show any proposed gradinc�cha�ges <br /> • Exisling and proposed utilitias • Show measurements � <br /> DO NOT\NRITE BELOW THIS LINE O <br /> PERMI'CONOITIONS <br /> 1.All cei�s for inspection shall be made 24 hrs.in advance-phone 259-8810. � <br /> 2.All woik shail be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> Standards end Specifications. <br /> 3.Cell localion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � ' <br /> r��rr ��, Q . <br /> ���� � <br /> /- 10 -9 d � <br /> , <br /> 0 <br /> a <br /> ACKNOVILEDGEAIENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to holtl and save harn- <br /> less the City of Everett irom any and all claims for damages, costs, <br /> expenses, or causes ol adion that may arise because of installation <br /> and main!enance of Ihe improvement or o�her righPobway use herelo <br /> applied tor and further a9rees lo remove same upon notice Irom ihe <br /> Approved for Construction Date Cily and to replace public property damaged thereby. <br /> FINAL INSPECTION Date — <br /> Approved as Consiructed SignnWre r.l ApplicaM Oate <br /> WORK �UTHORIZED 3Y TIiIS PERMIT MUST BE STARTED WITHIN <br /> evcrett PUBLIC WORKS D[PARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THER[AFTER IS TO <br /> � 32QOCedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BG <br /> Everetl,WA 98201 CANCfcLLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8810 PROJ[CT OVER 90 DAYS DURATION. <br />