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� � n�ei�c wo�As�'r� - <br /> oat�� �� <br /> a�,W o�o� • ' <br /> AnPlication Fo� __ <br /> PUBLIC WORKS PERMI�' "°""`""°".`°° s <br /> To,��F�a <br /> LrssAon�-FnePeitl $ —' <br /> OTI.InCfl�UI1 `4 <br /> Prinl or Type Only <br /> � � , �.�r�1,1 <br /> � Gty Zip Phonc <br /> Owner M2dmg Address <br /> qppllcant <br /> �lailing Address City� Lil' Phonr <br /> Describe Proposed Work –-- <br /> -- W <br /> Pro�eclAddressUlknown) B�ZZ� UP�r � � <br /> � <br /> Attach four(4)cop�ec u1 plans for pmposed work• Draw to scale anA note the followinc7 as apphcable: � <br /> • Property Lines • Centerfine ol slreet <br /> • Outhne and dimens�ons ol all e��stin�and • indicate Norih <br /> proposed structu�es on the lot • Shcw ary proposeA grading thanges <br /> • Exrsting and proposed utilities • Show nir.asurements M <br /> W <br /> DO NOT WRITE DELOW TH�S LIN[ O <br /> PERMIT CONDITIONS 1� <br /> 1.411 calls for inspec�ion shall be made 24 hrs.in advance-phone 259•88�0. <br /> 2.All work shall be periormed in accordance with this permit and current Ciry of Everett Design and Constmction � <br /> Standards and Specihwtions. � <br /> 3.Call Locaticn Underground Service 48 hrs.betore you dig.TOLL FREE NUMBER 1-800'424•5555. <br /> r�or �c�;►� �� O <br /> ���Z9 �B � <br /> 0 <br /> a <br /> ncKraow�r_ocen+erai or coNoirioNs <br /> Thr undaisi9nr,d ownei/apPhconi h�roUy agrees to hold and save harm- <br /> — lens Ihe City o� Everett hom any and all cla�ms for damages. eosls, <br /> expenses. o� causes of aclion that may arise because of instal ation <br /> and maintenance of ihe improvement or other right�of-way use hereto <br /> applied lor and furlher agrees to remove same upon notice Irom the <br /> AnProveA lo� Conslruc,ion Date Ci�y and to replace public property damaged ihereby. <br /> FINAL WSPECTION Oate Date <br /> Signature of Applicant <br /> qpproved as Gonstructed WORK AUTHnR12[D BY THIS PERMIT MUST BE STARTED WiTHIN <br /> rverelt PUBLIC WORKS DEPARTMEM 180 OAYS OF DATE PERMIT IS ISSU[D AND THEREAFTER IS TO <br /> � 3200CetlarStreet BE DILIG[NTLY PURSUED TO COMPLETION. THIS P[RMiT MAV �E <br /> Everell.WA 98201 CANCELLED BY THE CITY UPON ANY S10PPAG[OF WOPK ON THIS <br /> phonc 259�AB10 PF70J[CT OV[R 90 UAVS DURATION. <br />