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Date—L��6 D ��''� TO (�S l l��G� '� <br /> � � , � b • $� P�oi�c WnrkyPermi� �',�_C„�/+6 <br /> Application For e'ec 000�.•_�U-� ���C:.1y=1`_1 <br /> PUBLIC WORKS PERMIT P��LCWodafee ,- - <br /> Totrl Fee <br /> LessFO�� FeePaid $ <br /> eaiance o�o S ZD� <br /> Print or Type Only <br /> � �.l�'�I� .�l(_� �S'/YU �H'1 �,;E'_ �,1 ',f'X�iT ��'� i <br /> Owner Mailing Address City Zip Phone <br /> Applicant Ma;ling Address City Zip Phone <br /> Descnbe Proposed Work bl l / J1�/1C-J�� 1 //. � � � __ <br /> W <br /> Projec�Add�ess(il known) � - � <br /> Attach four(4)copies ol plans loi proposed work- Draw to scale and note Ihe following as applicable: � <br /> • Property Lines • GenterGne oi street � <br /> • Outline and dimensions ol all existing and • Intlicate North <br /> proposed structures on the lot • Shew any proposed grading changes <br /> • Eristinq and proposed u�ilities • Show measwements � <br /> DO NOT WFITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls lor inspection shall be made 24 hrs.�n advance-phone 259-8810. � <br /> 2.All work shall be pedormed in accordance with ihis permit and wrrent Ciry of Everett Desinn and Constmction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLI FREE NUMBER�-800•424•5b55. � <br /> O <br /> � <br /> N <br /> O <br /> a <br /> A� ACKNOWLEDG[MENT O�CONDITIONS <br /> �b The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the Cily of Everett Irom any and all daims for damages, costs. <br /> /� ���� /D/�/� expenses, or causes ol action that may arise because of installa�ion <br /> ��� and maintenance ol the improvemenl or other righ4ol-way use hereto <br /> �c.—K� applied lor and furlher agrees lo remove same upon nolice Irom th� <br /> ApP�o�ed lor G6nstr tion .� �� Date City and to renlace publlc prop=rry damaged Ihere�y. <br /> �_ �' �� -s-�9 <br /> FINAL INSPECTION ' oace l ��' �Zy�y�� <br /> PUproved as Conslructed Si at r 1 hpplicant Date <br /> everett PUBLICN'ORKSDEPARTMHN7 W HORIZED BV THIS PERMIT i.IUST OE STARTED WITHIN <br /> � 3200CedarSlreel 180 DAYS Of DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> BE DILIGENTLY PURSUED TO COMPLETION. T41S PERMIT MAY BE <br /> EveretL N'A 98201 CANCELLED BY THE CITY UPON ANY STOPPAGZ OF WORK ON 7HIS <br /> Phone:259-8810 PROJ[CT OVER 90 DAVS DURATION. <br />