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Datel�-�� ''�`� � PuD1ic Works Permlt�� <br /> Application For BIap.Oept t�� <br /> PUBLIC WORKS PERMIT P��I�cWorkeFee <br /> .o�a�F.a s <br /> �ess nooi.Fea ve�e S <br /> Balance Due S <br /> Print or Type Only <br /> �Bc� ��udc�. 1�.Nc�1mi�.r �ga1t ��� �1.�� �� � i ��9 t.� <br /> Owner Mailing Addrass ity Zip Phone <br /> a�cn�.�Ta�n � �a3o �,� Pc ��r= �.�,�- �� ���-�c�, <br /> App ent Mailing Address City � Zip Phone <br /> Describe Proposed Work . lrll�l)I n�I\ ) <br /> Pro�ect Address(if known) ��_b��Q��l C � <br /> Attach lour(4)copies of plans lor proposed work- Draw to scale and note Ihe following as applicable: � <br /> • Property Lines • Centerline of street � . <br /> • Outline and dimensions of all existing and • �ndict�te North <br /> proposed Structures on the lot • Show any propOsed grading changes <br /> • Existing and proposed utilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hra in advance- phone 259•881 5. � <br /> 2. All work shell be pertormed in eccoMance with this permit and current City of Everett Design and Construction <br /> Stendards end Specifications. <br /> 3. Call Location Underground Service 48 hrs. befor��you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> �lU..�L/G CdO.e�f"-r PF�P/»/T /UOT �(� O <br /> �� � <br /> �Z9-87 � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm� <br /> less the City of Everett from any and all claims for damages, wsts, <br /> expenses, or causes ot a�:tion that may arise because of installa�ion <br /> antl maintenance of ihe improvemenl or other right-oFway use hereto <br /> applied for and further agrees to remove same upon notice irom lhe <br /> Approved for Construction �a�e City and to replace public property damaQed thereby. <br /> FINAL INSPECTION Date <br /> Approved as Consiructed Sipnature of Applicant Date <br /> everen PUBLIC 1NORKS DEPARTMENT WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITIi1N <br /> � 3200 Cedar Slreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEFl IS TO <br /> Everetl,WA 98207 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WURK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />