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Date � � / � • • Public Works Pnrmit• <br /> Application For eiae o�oi.� �� ���y� <br /> PUBLIC WORKS PERMIT Pu0licWorksFee <br /> Total Fee s— <br /> Less AVP�Fee Peia S <br /> Balance Due S <br /> Print or Type Only <br /> ���C� I 11L-"}2K'Cl. 2Zc�"�, Cocr�i'��( .�� �rY1e�lT `� �201 Z� o.'Ja� <br /> Owner Mailing Address City Zip Phone <br /> Applicant Mailing Address City Zip Phone <br /> l <br /> DescribeProposedWork-��h'1O�le �-'��.'L1 EK(5 1 INC-, �1�YLFlC,->E% z ��1�CC WITtf' I��EW ��E' <br /> Proiect Address(if known) �Z� 3 V�-'CKC�1L� � `—vL12�� �1"� � � <br /> � <br /> Attach lour(4)copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Cenlerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> � Existing and proposed utilities • Show measurements � <br /> DO NOT WFITE DELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls tor inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit a�d current City of Everett Design and Consiruction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dio.TOLL FREE NUMBER 1•800•424•5555. � <br /> �O %�c>G/�' GG��,F',�s �F,�/�iT 0 <br /> �'���L�/k�.0 - ' �.. <br /> ��'����- � <br /> .�_� � -, � <br /> c " �7 . O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undcrsigned owner/applicant hereby agrees lo hold and save harm- <br /> less the Cily ol Everefl irom any and all claims for damages, cosis, <br /> expenses, or causes of action thal may arise because of installation <br /> and mainlenance ol ihe improvement or other righl�of•way use hcreto <br /> applied for and turther agrees to remove same upon notice irom the <br /> Approved for Construction Date Ciry and to replace public properry damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ot Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED Bl' THIS PERMIT MUST BE START[D WITHIN <br /> � 3200 Cedar Street 180 DAYS OF DATE PERMIT I£ ISSUED AND THEREAFTER IS TO <br /> Everetl,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />