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r <br /> Date�u �/ . • Pu�l¢Wo�ks PermDit��� <br /> Application For eioa.ocoi.•—p_fl_ <br /> PUBLIC WORKS PERMIT Publ¢WorksFce <br /> ,o�e�F�a s <br /> Less Aoo�.Fee Pard � <br /> Balanco Due 'J <br /> Print or Type Only <br /> �ku�,/Ql ,6'� 1�.� I�o 1 � Roc�/ln� /�,� Er�a�� 9�aa/ �.s a -9�`�j <br /> Owner aJing Address City Lp Phone <br /> Appli��ca� Mailing Atldress City 2ip Phone <br /> Desc�ibe Proposed Work �� � �, �/ .Si��D��/�rILfQ, <br /> - - W <br /> Prolecl Address(il known) '�- � <br /> Atlach four(4)copies ol plans for proposed work- Draw to scale and note�he tollowing as applicable: � <br /> • Property Li�es • Centerline ol sireet � <br /> • Ou�line and dimensions ol all existing and • Indicate North <br /> proposed s�ructures on ihe lot • Show any proposed grading changes <br /> • Eaisting and proposed utililies • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> t. All calls for inspectinn shall be made 24 nrs. in advance- phone 259•881 5. � <br /> 2 All work shall be performed in aCCordance wi�h this permit and current City ol Everett Design and Construc�ion <br /> Standards and Specilications. <br /> 3. Call Location Underground Service 48 hrs. br'�re you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> /"p ��� f E.E'sr.i �C'f-r'a'lii,�!-_,O �l�—v�6 F 7 <br /> � <br /> c��, � <br /> � <br /> O <br /> � <br /> ACKNOWLEDGEMEN7 OF i:ONDITIONS <br /> The undersigned owner/applicant hcreLy agrees to hold and s�ve harm- <br /> less the City ol Everetl trom any and all claims lor damages, costs, <br /> expenses, ur causes ol acticn ihat may arise because of instellation <br /> and maintenance of lhe improvement or ofher right-of-�+a'/ use hereto <br /> applied lor and further agrees �o removc same upon nolice from ihe <br /> Approved fOr Consiruction Date City and to replace public properly damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Sic�naWre ol Applicant Date <br /> eeere�t PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE S7ARTED WITHIN <br /> 180 DAYS OF DAT[ PEPMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Streel BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everetl.WA 98201 CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259•8815 PROJECT OVER 90 DAYS DURATION. <br />