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Date��' ��9 � • • PuCbt War�s Per�m.(i'l•� � ""�, <br /> Application For Bme�owi.+SL}�L.�3 ),�y� <br /> % � <br /> PUBLIC WORKS PERMIT PuphcWorksFee <br /> Tolel Fee S <br /> Le55 RpO��Fpe Pa�U S—. <br /> Print orType Onty eam��eo�e S <br /> 7 rr, /i9c L17t,��%/ /5��p — /l�ft� />l_' .S� �ii e/L°// <br /> Owner Mailing Atldress City Zip Phone <br /> 5�.�,� � _ <br /> Applicant Mailing Address Cily Zip Pho�.� <br /> Describe Pr;,posed Work �C �/Y�_ <br /> =s� �`��c� � C .� W <br /> Project Address(il known) ��. �� ��/"���j---�L�- � �' � <br /> Attach four(4)copies ol plans lor proposed work- Draw to scale and note�he lollowiny as applicable: � <br /> • Property Lines • Centerline ol stree� � <br /> • Outline and dinensions of all exisling and • Indicate Norih <br /> proposed structures on the lot • 3how any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1. All calls lor inspeclion shall be made 24 hrs. in advance� phone 259ti..i$. � <br /> 2. All work shall be perlormeA in accordance with Ihis permi�and current Ci�y ol Everett Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Unde�ground Service 4B hrs. before you dig.TULL PREE NUMBER 1•$00•424•5555. � <br /> �/ _7 � ��j�� O <br /> �E_�•r�rHi r /��' T .��C�U�2 FO C:�" _ _ ♦�A <br /> V♦ <br /> O <br /> a <br /> 4CKNOWLEDGEIv1ENT OF CONDITIONS <br /> The undr�s�yned owner/applicant hereby agrees to hold and save hanm <br /> less ;ne City ol Everett Irom any and all claims Im damages, cosis. <br /> expenses, or causes ol action Ihat may arise because ol installation <br /> and maintenance of ihe improvemen; or other right-ol�way use hereto <br /> applied lor and further agrees to remove same upon rolice Irom ihe <br /> Approved for Construction Date City and to replace publir.properry damaged therr.by. <br /> FINAI_ INSPECTION Date <br /> Approved as t:onsiructed Signature of Applicant De.te <br /> evemtt PUBLIC WORKS DE?ARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED �VITHIN <br /> � 3200 Cedar Sireel 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98207 Bc DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT I�1AY BE <br /> Phone: 259-881� CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK JN THIS <br /> PROJECT OVER 90 DAVS DURATION. <br />