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Date�g� P�plic Worxe Pormit• <br /> Applicatlon For eiav oaoi..�� <br /> PUBLIC WORKS PERMIT PuebcWodiFee <br /> To1al Fee f <br /> Lee!ApPL Fee VeiG s <br /> Print or Type Only Beience Due s <br /> MG��"�1n. K�JJ/dt�;�_ ��6 - 77TZ.ft' .S /T .��Prd/7L �O � <br /> Owner Mailing Address City - Zip Phone <br /> _�r>I a.l l�u;n �i��,u N����-�rr1��r,0� .S',��D6 E�fy,r,� as'�a 5��9 <br /> Appiicant Mailmg Address City Zip Phone <br /> Describe Proposed Work I PNAnX �14n i1 nr�ip.uwJ���I���� <br /> i <br /> Project Address(if known) � <br /> Attach four(4)copies of plans for proposed work•Oraw to scale and note the following as applicable: � <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO N7T WRITE BELOW THIS LINE � <br /> . , PERMITCONDITIONS O <br /> 1.All calls for inspection shall be matle 24 hrs.in advance-phone 259$81 O. � <br /> 2.All work sheil be pedormed in accordence with this permit and cuvent City of Everett Design and Construction <br /> Standerds and Specifications. <br /> 3.Cell Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800-4Q4•5555. <br /> � <br /> /��6��- ���-� �.�,..�-f/��-f��tY"°'L`�J � <br /> � �����o� <br /> � -7-9/ � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the City of Everett irom any and all claims lor damages, costs. <br /> expenses, or causes of action that may arise because of installation <br /> and maintenanCe ol ihe improvement or other right-of-way use hereto <br /> Approved for Consiruction applied for and furiher agrees to remove same upon notice fiom the <br /> Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Consiructed Signature of Applicant Dale <br /> yAr� PUBLIC WORKS DEPARTMENT 'JVORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CetlarStreet 180 DAYS OF DAfE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WAg8201 BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:259-8810 CANCELLED BY THE CITY U�ON ANV STOPPP.GE OF WORK O�THIS <br /> PROJECT OVER 90 DAYS DU�"!ON. <br />