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Date� Pu�bc Wurka Permil• <br /> Application For eiep.Dep�.+���y��� <br /> PUBLIC WORKS PERMIT Pu�TotefeeFee : <br /> Lees ADoI Fee P�iE s <br /> Belence Due S_ <br /> Print or Type Only <br /> �"��cd F_h�e%� 3/D( ��/0�� NOG ['vE��i �.,� .3s.�- ai�,3 � <br /> Owner Meiling Address City 2ip Phone ,�'9, <br /> ti� <br /> \�'a m e. • <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work �eS ldt'Nfi%L� �dd.l � QI�lh , P� LE'�1�e0.71Y1 y ,j <br /> y � <br /> W � <br /> Pro�ect Address(it known� 3 S�O�'�' � � <br /> Attach lour(4)copies of plans lor proposed work- Draw to scale and note the following as applicab'e: � � ri <br /> • Property Lines • Centedine ol street � � y <br /> • Outline and dimensions of all Psisting and • Indicate North <br /> proposed structures on the lo� • Show any proposed gratlir changes y <br /> • Existing and propo��d utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE `� <br /> PERMITCONDITIONS O � �.,i <br /> 1. All calls for inspection shell be made 24 hrs. in advance- phone 259•88�5. � ppp N <br /> 2. All work shall be peAormad in accordance with this permit and current City of Everet�Design end Consiruction � � <br /> Stendards and Specifications <br /> 3. Call Locetion Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER �•800•424�SSSS. � <br /> \ / O • � <br /> \n\�` �V ♦ � � <br /> � � W �% � N y <br /> � Q e <br /> � �� 3 0 � <br /> � � � � a � <br /> �o� c��� � � � �� <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less ihe City of Everett lrom any and all claims for damages, cosis, <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance of the improvemen� or other right-oi�way use hereto <br /> applied for and further agrees to remove same upon notice from Ihe <br /> Appioved lor Construction �a�e City and to replace pubUc property damaged Ihereby. <br /> FINAL INSPECTION Date <br /> ;pHroved as Constructed Signature ol Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WC7K AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 0 3200CedarSireet 180 DAYS OF DATE PERMIT IS ISSUED AND TIIEREAFTE� IS TO <br /> E�erett,WA 9G201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br /> Phone: 259�8815 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DP YS DURATION. <br />