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Date��� Publit Works Permit s � <br /> Appliwtion For eiao�oan� • <br /> PUBLIC WORKS PERMiT ��OToteFeaFee S <br /> Lasa Aoc� Fae Pnid $ <br /> Balence Oue S <br /> Print or Type Only <br /> 9�f:�� / <br /> ���/fi' �017£-� 3'F?, /S�� 1�cc.c�F'tf�L �� ��'T��'rr'"r..i.» J>-�nJ`� <br /> Owner Mai4ing Address Ciry Lp Phone <br /> Applicam Mailing Address Ciry Zip Phone <br /> DescribeProposedWork pn ��v� �'`�'gU <br /> W <br /> Proiect Address(if known) /� �7 �O CX£�.�'�� �'R � <br /> Attach lour(4)copies of plans tor proposed work• Draw to scale and note the following as applicable: � <br /> • Property Lines • Cenlerline of street � <br /> O Outline and dimensions ot all existing and • Indicate North <br /> proposed structures on the lot • Show any propose�f yrading changes <br /> • Existing and proposed utilities • Show measurr.ments /� <br /> W <br /> DO NOT WRITE BELOW THIS �INc O <br /> PERMIT CONDITIONS <br /> t. All calls tor inspection sliall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Ev�erett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424-5555. � <br /> O <br /> � <br /> �F�i.�// 1��i/F� � <br /> o�, _ �/y,s �C'CFSS c�' %��r fi«E/, � <br /> � <br /> \ � ;' !'��'C-"�Cf+/✓T /.k�Tific��J �J-Z k 8 E' O <br /> . � � ��� a <br /> � ' c� �� <br /> , <br /> �¢`� �e�' <br /> o �. <br /> �p ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City of Everett frem any and all claims for damages, costs, <br /> expenses, or causes of action thal may arise because of inslallation <br /> and mainlenance of the improvement or other right-obway use hereto <br /> applied for and further agrees to remove same upon notice Irom the <br /> Approved for Conslruction Dale Cily and lo replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> qpproved as Constructed Signature of Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC 4VORKS DEPARTM[NT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 CeAar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> [�•eret;.VJA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Frcne: 2E9�8815 pROJECT OVER 90 DAYS DUFATION. <br />