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�8t@�y� PuElie Works Fe�m1i• �� I <br /> r <br /> ' ApplicationFor ema.00e�.. ���� ��"i I <br /> PUBLIC WORKS PERMIT PueToblFeeFee s <br /> Leae A001.Fee P�iC S�g _ <br /> Belence 0ue S.G�� <br /> Print or Type Only <br /> O� •�� ��ail�ng�,4ddress��� Y Clly � �� ��Zp�) p����������) <br /> ��_(�'C1�.`�". ���=�. I �G�'.�1� �� ll`,���ll ��l�L_���C)S� �'�'rl�—`1 ���. <br /> Appllcant Meiling Ad�lress �ity 2Ip Phone <br /> Deacdbe Propoaed WorY, ��l P�i-�. <br /> , , � � W <br /> Proleat Address pf known) � <br /> Attech four(4)coples of plans for proposed work•Oraw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline of sireet � <br /> � Outline and dimensions of all�xistinp and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Exisling and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMITCONDITIONS <br /> 1. All calls for Inspection shall be made 24 hrs. in aCvance• phone 259•8815. � <br /> 2. All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br /> Stendards and Specilications. <br /> 3. Call Locetion Underpround Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> /1 Cl ACKIJOWLEDGEMENT OF CONDITIONS I <br /> � 7� The undiersigned owner/apPlicant hereby agrees to hold and save herm• � <br /> iess ihe City of Everett Irom any and all claims for damages, costs, <br /> expense:, or causes of action that mey erise because of installation <br /> �����,�� � /'7/d� and maintenance of the improvement or other right-of�wey use hareto <br /> � applied for and furthes agrees to remove seme upon notic� from �he <br /> Approved lor Constru/ction a�e City and to replace,pabliC property damag d ereby. <br /> �- ��'Cj/ <br /> �//�/ /-�� /� �c .�-J �� x��_ �/) n ' / / - <br /> INSPEC ON Date \;�/ ! ��/ C L\��i�iY3��� <br /> Approved as Constructed ignat re of App`licant' ,� Dete � <br /> everett PUBL.IC WORKS DEPARTMENT WORK AUTNOR�ZED BY T!ti� PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF ��TF PE:tMIT IS ISSUED AND THEREAFTEFl IS TO <br /> Everet�,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION, THIS PERM�T MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TiIIS � <br /> PROJECT OVER 90 DAYS DURATION. <br />