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� �BtEC]..�� PUEec Worb Per • ��� <br /> � � %/�'�/ <br /> AppliCation For eiea.oeo�.• T_ <br /> PUBLIC WORKS PERMIT PuohcWorbFee <br /> To1�IFee f <br /> . Lesa ApO�Fee P�iC S <br /> B�I�nce Due �- ��.�� <br /> Print or Type Only <br /> � X�FJ\l y*�a�-Ka.� ��/�,-�Z C�tc�r �,?� ' 7/a✓� <br /> �wnAr Mailing Atldress City Zip Phone <br /> Applicant Mailing Address City Zip Phone <br /> Describe ProUosed Work `` <br /> W <br /> Prolec�Address(if known) � <br /> Attach four(4)copics ol plans lor proposed work•Draw to:�ale and note the following as applicable: � <br /> • Property Lines • Centedine o1 street � <br /> • Outline and tlimensions of all ezisting and • Indicate Norih <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Eziating and proposed uti�ities • Show measurements � <br /> � DO NOT WRITE BEIOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•8815. � <br /> 2. All work shall be perlormed in accordance with this permit and current City ol Everett Design and Construction <br /> Standartls end Specifications. <br /> 3. Call location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•80n•424-5555. � <br /> O <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City ot Everetl trom any and all claims for Camages. cosis, <br /> expenses, or causes of aclion that may arise because ol installation <br /> ������ j �j ,�i� and maintenance ot ihe improveme�t or other right-o4way use herelo <br /> �� applied lor and lurther agrees to remove same upon notice trom the <br /> Approved f r Consiruction � City and to replace public property damaged thereby. <br /> �� l , <br /> ��l- �� i v-d�� <br /> FINAL�SPECTION Date <br /> Approved as Conslructed Signature ol Applicant Date <br /> everett PUBLIC INORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT �S ISSUED ANO THEREAFTER IS TO <br /> Everett,WA 98201 BE DIIIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8815 CANI,ELLED BY THE CITY UPON ANY STOPPA�E OF WORK ON THIS <br /> PROJECT OVER 30 DAYS DURATION. <br />