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Date_� P�o�,�wo,�sP�,m,i_ '`X L'�'".�—� <br /> BIaB Doot•� <br /> Application For <br /> PUBLCC WORKS PERMIT PuoTotelFea`eB S <br /> Lesf RDo�Foe Para S <br /> Daienca Due � <br /> Print or Type Only <br /> � h �.C.o / v /C�n G\ �u�-t' � <br /> Owne� Maiting Address City Zip Phone <br /> �' -� c�-�-� � - a��y <br /> Applican� Mailing Address City Zip Phonc <br /> Desa�ibe Proposed Work <br /> � IC-o�.., i � rn G�� �ff�J�<-t��✓t <br /> — W <br /> Pwject Address lif known) v � <br /> � <br /> Attach four I4)copies ol plans lor proposed work-Dra�v to scale and note Ihe following as applicable: � <br /> • Property Lines • Centedine ol streel <br /> • Outline ana dimensions of all existing and • Indicate Norih <br /> p�oposed slructures on the lot • Show any proposed grading changes <br /> • Existing and proposed utili�ies • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> t. All calls for inspeclion shall be made 24 hrs. in advance- phone 259•S8�5. � <br /> 2. All work shall be periormed in accordance wi�h this permit and curreM City ol Everett Design and Construction <br /> Standards and Specilications. � <br /> 3. Call Location Underyround Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> 7� � <br /> / �������- ��'�)���.y-� '?—,o ��;'l . =/C'/ . �_ -j,��///�/`�' <br /> f� i � � <br /> �_��Er � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> 7he undersigned ownedapplicani hereby agrees to hold and save harm� <br /> less Ihe City cf Everelt Irom any and all claims for damages. costs. <br /> expense;;, or causes ol aclion that may arise because ot installation <br /> and maintenance ol the impro••ement or olher righbobway use herelc <br /> ypplied lor and turiher agrees lo remove same upon notice ��om the <br /> Approved lor Construction Date Cily and lo replace public property damaged thmeby. <br /> FINAIINSPECTION Date -- Date <br /> Approved as Consiructed SignaWre ol ApplicaN <br /> WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br /> 0 everett PUBLIC WORKS DEPARTM[NT 180 DAYS OF DATE PERMIT IS ISSUED AND THFREAFTER IS TO <br /> 3200 Cedar Slreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> EvcretL WA 98201 CANCELLED 6Y THE CITY UPON ANY STCPPA3E OF WORK GN THIS <br /> Phonc: 259�8815 pROJECT OVER 90 DAYS DURATION. <br />