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Date%%�y r�oi��won.rs,mn. _ <br /> Application For einy D�o�.+ _ <br /> PUBLIC WORKS PERMIT PubhcWabfee - <br /> iatal Fee _ <br /> le5s�p0� PAiE S _ <br /> Print or Type Only ea�r o�� s <br /> /�'� ��ers ��e�tYie, �� .L��//5Z c��eret� �9 !`�,� �-S�.�/07' <br /> Owner Mailing Atldress C�ty Zi Phone <br /> �-�a���e �s �.� r,,ti e <br /> Appliwnt Mailing Address City Zip Phone <br /> / ,, � f � <br /> Oescribe Proposed Work n-�'� -�✓ ��!_YG�LE..�� //YIJ ��e(�/ <br /> Proiect Adtlress(il known� � � �� ���/ �C- � <br /> Atlach lour(4)copies ol plans for proposed work- Draw to scale and note Ihe tollowing as applicable: � <br /> • Properry Lines • Centerline of sireet � <br /> • Outline and dimensions ol all existing and • Indicate North <br /> proposetl structures on ihe lot • Show any proposed grading changes <br /> • Ezistmg and proposed utili�ies • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and cunent City of Everett Design end Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> � �–k��-�,;L,� �..=��`J�i/�C�- �c�'/� r� � <br /> �� T,� ��o� � <br /> � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to holtl and save harm� <br /> �--�� less the City of Everett Irom any and all c�aims lor damxges, cosls. <br /> expenses, or causes ol adion Ihat may arise becxuse of installation <br /> ��,� i� and maintenance ol ihe ImprovemeN or other rigMrohway use herelo <br /> �� applied lor and luriher agrees lo remove same upon notice from the <br /> p oVed Ior.ConStfuction Date <br /> f . Ciry anA to replace public property damaged Ihereby. <br /> AL INSFECTION Date �"� ��'����t— <br /> roved as Construc�ed Signa ol Applicant Dale <br /> cre�l f UBLIC WORKS DEPARTMENT WORK THORI2ED BY THIS PERfvl1T MUST BE STARTED WITHIN <br /> 3200CetlarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,W/�9A207 BE DILIGENTLY PURSUED TO COMPIETION.THIS PERMIT MAV BE <br /> Phone:259•8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />