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<br /> AFplication For oi�u oen� •
<br /> PUBLIC WORKS PERMIT P°�����W�,�s��� —
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<br /> Ownei Malling Adtlress Cily 2ip Phone
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<br /> Applican Malling Address City Zip Phone
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<br /> Attach tour I�I copies of plens lor proposed work� Dr:�w to scale and note ihe lollowing as applicable� �
<br /> • F�roperry Lines • Centeiline ol street �
<br /> • Outline and dimensions of all existing antl • Intlicate North
<br /> proposed structures on the lol • Show any proposed grading changes
<br /> • Eristing and prcposed uliliies • Show measurements �
<br /> DO NOT WRITE BELOW THIS LINE O
<br /> PERMIT CONOITIONS
<br /> 1,All calls lor inspection a•hall be made 24 hrs.in advance-phone 259•8870. �
<br /> 2.All work shell b[�peMormed in ar,cordance with this permit and cu«ent City of Everett Design and Construction
<br /> Standards and Specifications.
<br /> 3.Call Location UnderFround Service 48 nrs.before you dig.TpLL FREE NUMBER 1•800-424•5555. �
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<br /> �j �-f.p���fr,i���_ /2.2 -UZ/'✓d�''� �undersigned owneUapplicant hereby agrees to hold and save harm�
<br /> - less the City of Everetl irom any and all claims f�i Aainayes. cosis,
<br /> � ezpenses, or wuses o: aclion ihat may arise because of installatio i
<br /> ��r �' ./ p and main�enance ol the imprevemenl or other right�of-way use hereb
<br /> f�7r��'"Z l' �2��/� applied (c r and 'uriher agrees �o remove same upon natice irom th
<br /> Approved for Co s�tr/�r�tion Date q�y and to replare public property damaged thereby.
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<br /> FINAL INSPECTON Date � � � f"� —�
<br /> AFproved as Consiructed S�gnature o Appiic ` Date
<br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORI ��Y THIS PERMIT MUST BE STARTED WITHIN
<br /> 180 DAYS OF DATE P[RMIT IS ISSUEI) AND TIiEREAFTER IS TC
<br /> � 3200CedarStreet BE DILIGENTLY FUHSUED TO COMPLETION. THIS PERMIT MAY BE
<br /> Everetl.WA98201 CANCELL[D BY THE CI?Y UPON ANY STCPPAGE OF WORK ON THIS
<br /> Phone:259�8870 pqOJECT OVER 90 DAYS DUfiATION.
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