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�BtQ__'�%� / � PuOLCWorksVermit• I <br /> AppliCation For eiao oeo� •_ � <br /> PUBLIC Vi/ORKS P�RPJIIT PobhcWorkeFee <br /> Te„�F�a s <br /> lesa RDo�Fee V.N 1 <br /> Belance Due S <br /> Print orType Only , <br /> -�,.��u.��_ 3�J/7`'C�.`�` <br /> Owner MaJing Address City Zip Phone . <br /> � <br /> Applicant Mailing AAdress City Zip Phone <br /> Deacribe Proposed Work __ � �—Q <br /> /I � — — <br /> l/ <br /> Project Atldresc(if known) __ � - - � <br /> —� � <br /> Altach four(4)copies ol plens for proposed work•Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline of street � <br /> � OuNine and dimensions ol all ezisting and • Intlicate North <br /> propoaed structures on the lot • Show any proposed grading changes <br /> • Existing anA propowed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O , <br /> PERMIT CONDITION.S I <br /> 7. All c:,lls for inspection shall be made 24 hrs. in advance-phone 259•881$. � <br /> 2. All work shall be pertormed in accerdance with ihis permd and current City ol Eveiett Design and Construction <br /> SlanderCs and Specificalions. � <br /> 3. Cali Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1•800•42O•SS55. � i <br /> � /�E.Qirii� il/oT �r'E`y�o�.�EO �/(0/86 O <br /> �� � i <br /> �� ; <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owneVapplicant hereby agrees to hold and save harm- <br />. less the City of Everett from any and all claims lor damages, costs, <br /> expenses, or r.auses ol aciion that may arise because ot inslallation <br /> and maintenance ol the improvement or other right-ot�way use herelo <br /> Approved lor Construction Date applied for and further agrees to remove same upon notice Irom the <br /> City and to replace public property damaged thereby. <br /> FINAL INSPFCTION Date <br /> Approvetl as Constructed Signature ol Applicant Date <br /> PUBIIC WOFKS DEPAqTMENT �'ORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � i:200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMlT MAY BE <br /> Everett.WA 98207 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Ph,one:259�8815 PROJECT OVER 90 DAYS DURATION. <br />