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,-�-- <br /> Date�� Publ¢Worts Pmmil� _— <br /> Application For eioo oeo�.• <br /> PUBLIC WORKS PERMIT FubucWorMSFee <br /> Totnl Fae $ <br /> Less Appt Fee Paia $ <br /> Print or Type Only Baiance Due 5 <br /> .-6eu�rn�ru f�lid•t �/s .F; J�r, „o_ i�1�,6� /�, 35 3—�OG z5 <br /> Owner Mailing Address City Zip Phone <br /> hhn�r� iin � � l��Sn�l,n�„s� � Q� ,� �o s�� -�,�� -- <br /> AppliCan� Maiiing Address Cily 2ip Phone <br /> Descri6e Proposed Work � � �g_���/�� <br /> /- W <br /> Project Address(il known) __��p �o� �.�_ � <br /> � Attach four(4)copies ot plans lor proposed work� Draw to scale and note the lollowing as applicable: � <br /> � • Property Lines • Centerline of sireel � <br /> • Outline and dimensions oi all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BL-LOW THIS LINE O <br /> PERMIT CONDITIONS <br /> - 1.All calls for inspection shell be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be peAormed in accordance with this permit and current City ot Everett Design and Construction <br /> Stendards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424-5555. � <br /> �l.�//c�/ ��/_.f%1/!rr-�n /t.C�T �S'��CJ-G'�,e�' _ O <br /> � v <br /> �zb -8� �' <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned ownedapplicant hereby agrees to hold and save harm• <br /> ,� less lhe City ol Everelt Irom any and all claims for damages, cosis. <br /> ° expenses, or causes ol aclion that may arise because ol inslallation <br /> and mainlenance ol Ihe improvement or other right-ol•way use hereto <br /> Approved lor Construction Date applied lor antl lurther agrees to remove same upon notice irom �he <br /> Cit and lo replac pubG property damaged ihereby. <br /> FINAL INSPECTION Da�e a � <br /> Approved as Constructed Si re ol App ican `Date <br /> everelt PUBLIC WORKS DEPAR7MEN7 WORK AUTHORIZED V THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CetlarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Cverett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:�59-8810 CANCELLE�BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />