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Date�.�adQ� PuOuc Woda Pe � <br /> Application For e�ee o�oi.• <br /> PUBLIC WORKS PERMIT PublicWo�xnFee <br /> Total Fex S <br /> Less RooL Fee Pnd S <br /> Balenca Dun S <br /> Print or Type Only <br /> �len �cl�.r ►n�j���mC���+�� 9�D I � <br /> Owner Mailing �dress Cdy Lp Phone <br /> � n ln � �NS �'.n 11 C'p ��2 AU� . � .?C1�.4��Y1 q8�1�— <br /> Applica Mailin�Address City Zip p e <br /> /1� � <br /> Describe Proposed Work �1--� . _ _ <br /> Prn'arl Addrn<c/'f knnwN I�� - � <br /> Atfach tour(4)copies of plans for proposed work• Draw to scale and nole the lollowing as aUPlicable: � <br /> • Property Lines • Centerline of strael � <br /> • Outline and dimensions of all ezisting and • Indicate North <br /> proposed siructures on ihe lot • Show aoy proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phcne 259•8810. � <br /> 2.All work shall be pertormed in accordance with this permit and current City ol Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Cell I_ocation Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �/�BL/C Gc�.e�s' �.P/n�T��T' ,P,��/i.e�'D �3�2��yB O <br /> �_,�� � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMFNT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees lo hold and save he�m- <br /> less the City of Everett Irom any and all claims lor damegos, cosis, <br /> expenses, or causes of action ihat may arise because of instellation <br /> and maiMenance ot lhe improvement or o�her right-ol-way use hereto <br /> applied lor and further a9rees lo remove same upon notice Irom the <br /> Approved lor Constructinn Date City and to replace public properly damaged thereby. <br /> FINAL RiSPECTIOK Date <br /> Approved as Conslructed Signature ol Applicant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMI7 IS ISSUED AND THEREAFTER �S TO <br /> Everelt,WA9820! BE DILIGENTLY PURSUED TO COMPLETION.THIS PEFMIT MAY 8E <br /> Phone:259�8810 CANCELLED BY THE CITV UPON ANY STOPPAGE CIF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />