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n <br />. .. ___ ., � ._..—� �Ait•'�...,Yw`F <br />� �. . <br />Date��� <br />qpplication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />10 �i�l\S �� ,.� �K.;llCl �� C i <br />Owner � Mailing <br />(�[.c�ti/�L' G� ` � <br />Applicaot Maiung <br />Describe Proposed Wo�k �' <br />; <br />Proiect ACdress lil knownl �!� <br />1'uM¢ Wurks Pnrmtl � <br />Biag Oent � _7/ � ' _i �� <br />Pu�l¢Worksfea s <br />T�i,i r�� <br />leae Appl Fne PriO S <br />Balxnce�uc i <br />( �Li..,� <br />I -��.,., v�:- �'� ��.. I� .���� . ci3�z <br />City Zip Phone <br />I�%`f-�•�' <br />City Zip Phone <br />Attach �our (4) copie3 of plans lor proposed work - Dra�to scale aad note ihe lollowing as applicable�. <br />� Properry Lines • Centerline of street <br />• Outline end dimensions of all existing and • Indicale Norih <br />proposed struclures on the lot • Show any proposed grading change.s <br />• Exisling end proposed utilities • Show measurements <br />DO NOT WRITE BELOW THIS IINE <br />RMIT CONDITIONS <br />' 1. All calls for inspectlon ;nall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shell be pe�sormed in accordance with Ihis permit and current City of Everett Design and Construction <br />"� Stendards end Specifications. <br />3. Cell Locelion Underground Service 48 hrs. before you dig. TOLL FRFE NUMBER 1•800�424•5555. <br />\ � ��!' <br />�(..���� C �lfUL�e� �-�,�e � <-/� <br />/�/c-f /•�.� c^sn.e�.i� � _ <br />�, <br />�%.i!,,�;�,�� <br />.. ; �, �e,��� <br />;- ,.. <br />Approvetl tor <br />Date <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />0 <br />a <br />ACKNOWL[DGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less Ihe City of Everett Irom any and all claims for damages. cosis, <br />ezpenses, or causes of action Ihat may arise because of installation <br />and mainlenance ol Ihe improvement or o�her nght-o:�way use here�o <br />applied for and lurther agiecs !o remove same upon notice from the <br />City and to replace public property damaged thereby. <br />FINAL INSPECTION �, Date <br />Approved au Constructed Signature ol Applicant Date <br />WORK AUTIiORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />everett PUBLICWORHSDEPAR7MENT i80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />� 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Everet4 H'A 90201 CANCEI.LED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone:259�8810 PROJECT OVER 90 DAVS DURATION. <br />