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�, _�g� 88-zo <br /> Date Pu�hcWorkaPermi • <br /> Application For eiaa Deo��•� <br /> PUBLIC WORKS PERMIT F°b�,°W°��,F°° <br /> .o„�Fe� s <br /> Less�oo�.Fee Pe'�a S� <br /> � Baiance Due $ �� <br /> Print or Type Only <br /> `L���v�1 n /�� �i��� 1�I�9 F3�/��� Y��L r�� <br /> Owner Mai{ing Address City Zi Phone <br /> 1�f I� <br /> Applicent Mailing Address City Zip Phone <br /> � Describe Proposed Work I K-!iV CJi� l��� �� J� vC� '� W 1 /-� <br /> f� t���� �c�r�2F <br /> ; <br /> ' � `, W <br /> ' Pro�ect Address(il known) � . ,/� �2 g" • E � <br /> r Attach four(4)copies of plans lor proposed work• Draw to scale and note the following as applicable: � <br /> � • Property Lines • Centerline of street � <br /> • Ouiline and dimensions of all ezisting and • Intlicate North <br /> - proposed structures on the Iot • Show any proposed grading ch;nges <br /> • Existing and proposed utilities • Show measurements � <br /> �. DO NOT WRITE BELOW THIS LINE <br /> F PERMITCONDITIONS O <br /> r <br /> 1.All cetls for Inspection shall be mede 24 hrs.in edvance-phone 259•861 O. � <br /> 2,All work shali be perlormed in accordance with this permit and currenf City of Everett Design and Construction <br /> � Stendards and Specifications. <br /> � 3.Call Location Und=rground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEM[NT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Gty of Everetl Irom any and all claims tor tlamages, costs. <br /> /, / expenses, or causes of aclion that may arise because ol ins�al!ation <br /> l����, `— � /��/A8 and maintenance of ihe improvement or other right�ol�way use hereto <br /> v«�� � /� applied lor and further agrees o remove same upon notice trom the <br /> Approeed for Const u n ate i�y and to replace public pr per damage ereby. <br /> 3—�/—�G � � Q� <br /> FINAL INSPECTION Date <br /> Approved as Cnnstructed ignature ol Applicant D te <br /> everett FUBLIC WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED ANO THEREAFTER �S TO <br /> Everett,WA98201 BE DI�IGENTLY PURSUED TO C(;MPLETION. THIS PERMIT MAV BE <br /> Phone:259�8870 CANCELLED BY THE CITY IIPON ANY STOPPAGE OF W(1RK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />