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Date����°1 ' ` �`'5y�--7� <br /> , ..�� ��,.�.��;ti•;�.,..sP,.,���r <br /> Applicatlon For �1°° °c•°� • —=/- ��� <br /> PUBLIC WORKS PERMIT P�����<<v���5F1e ------- - -- <br /> ,o�T���e s_. <br /> less nnoi Fee va�e 5 <br /> Print or Type Only oa�,�=�o�� s _ <br /> ���:�C�.l(�,1, �'2_/1.� i 5�5 ���C��2/' �/.�'J�r� 8a0I — <br /> Owner Mading Address � Ciry Zip Phone <br /> ���/3 <br /> Apphcant Mailing Address City Zip Phone <br /> Describc P�oposed Wark �lf�7 C/��l___ / r�{_! ����1 �/ <br /> Proied Address(if known� /��� � <br /> � <br /> Attach lour(4) copies of plans lor proposr.d work- Draw lo scale antl note thr. following as applicable�. � <br /> • Property Lines • Centerline ol sireet � <br /> • Outline and dimensions of all ezisting and • Indicate North <br /> proposed siructures on the lot • Show any proposed grading chanyes <br /> • Existing and proposed utihties • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for i�spection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be pertormed in accordance with this permit and current City of Everett Design and Consiruction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•$00•424•5555. � <br /> IUDT /�'C�,. O <br /> ��� `�- I- <br /> in � 3 � o �� � <br /> � <br /> a <br /> ACKNOWLEDG[MENT OF CONDITIONS <br /> The undersigned owneUapplicant hereby agrees to hold and save harm� <br /> — less ;he City ol Eveiett Irom any and all claims for dama�es, costs, <br /> e*penses, or causes of action lhat may arise because ol in;tallation <br /> and mainlenance ol the improvement or other righPol�way use hereto <br /> applied lor and further agrees to remove same upon notice from the <br /> Approved lor Construction Oa�e City and to replace publ;c pwperty dama9ed Ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Consiructed SignaWre ol Applicant Date <br /> everpt[ PUBLICWORKSDEPARTMENT WnRK AUiHORIZED BY THIS PERMIT MUST BE STARTED JJITHIN <br /> � 3200CedarStreel 1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA99201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT IdAY BF <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAY^ DURATION, <br />