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�� � , .i <br /> Date ii =rr' ��� �-„�,�-<<•;�,��v„���n�<'<�� <br /> Application For �1°`� o"u�.,—1L-1t�`, ��— <br /> PUBLIC WURKS PERMIT �°�,°°�,�«jF�� - -- <br /> .o�T�Feo s — <br /> Less RpO�Fce Paltl 5 <br /> Print or Type Only , d,�,�=a o�e S <br /> i��1 ���sr�� q��as �rd� 1=)ve �J� ��r�1it� ��i i 5 ��-� <br /> Owner M�ling Address Cily Zip Phone <br /> �1�he Ki��a (��,�� <br /> AppI�J� Mailing Address City Zip Phone <br /> Describe Proposed Work �1_4� . 1 1 I l� <br /> Project Adtlress(it known) ��� �r- � � � <br /> � <br /> Attach lour(4) copies ot plans fo�proposed work- Draw to scale and nnte ihe lollowin�as applicable: o <br /> • Property Linas • Centerline ot street /�, <br /> • Outline and dimensions of all existing and • Indicate North � <br /> i/ <br /> proposed structures on ihe lot • Show a�iy proposed gradin� changes <br /> • Existing and proposed utilities • Show measuremonis � <br /> DO NO7 WRITE BELOW THIS LINE <br /> PERMITCONDITIONS � O <br /> t.Ail cails lor insnection shall 6e made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be pedormed in accordance with ihis permit and current Ciry of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 4&hrs.be(ore you dig.TOLL FREE NUMBER 1•S00•424-5555. � <br /> i \�?�- t`�C�/��I��£'D ,..�� Q Z/�SB O <br /> ��'�� �// <br /> � <br /> � <br /> Q <br /> A. <br /> �CKNOWI.EDGEMENT OF CONDI710NS <br /> The�.��der;ipned owner/applicant hereby agrees to hold and save harm- <br /> — less the City of Everett from any and all claims for damages. cosis, <br /> expenses, or causes ol action that map arise because of installalion <br /> and maintenance ol the improvement or other right-of-way use hereto <br /> ApProved lor Construction Date �PPlied lor and turther a9rees to remove same upon notice from ihe <br /> City and to reptace public property tlamaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Consiructed Siynature of Appiicant Date <br /> everet: PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST QE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS IS3UED AND THEREAFTER IS TO <br /> Everett,WA98201 8E DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BF <br /> Phonc:259-8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF NJORK OW THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />