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Date I�[2 � / <br /> - Pu���c Works Permi __ <br /> Application For ome oea�.. _ <br /> PUBLIC WpRKS PERMIT P����=W�«9LeP — " <br /> Totxl Fae S_ <br /> �uss Aooi Fee Pa�a 5 <br /> Print or Type Only °a1nCpor S <br /> �L�Vl lU �AK.�,� � f\�� � t�f'�l�� <br /> Owner �ading Add�ess City Zip Phone <br /> �f� <br /> ypplicant Mailing Address City Zip Phone <br /> Describe Proposed Work ��r�� 1 �1�� _ <br /> Prolect Addre55(il known) 7 � <br /> Attach lour(4)copies ol plans lor proposed work� Draw to scale and note the lollowing as applicable: � <br /> • Properry lines • Centerline ol street � <br /> • Outline and dimensions of all existing and • Indicate Norlh <br /> proposed structures on Ihe lot • Show any p�oposed�iading changes <br /> • Eaisting and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> � PERMITCONDITIONS O <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 2S9•8810. � <br /> 2.All work shall be peAormed in accordance with this permit and currenl Ciry ol Everett Design and Consiruction <br /> Standards and Specifications. <br /> 3.Cal�Location Underground Service 48 hrs.belore you dig.TOLL FREE NUMBER 1-800-424•5555. � <br /> 1' O <br /> f � `� ' �.°� � <br /> � '�� � <br /> �!' <br /> �'�� 5 �� a <br /> �� <br /> / ACKNOWLEDG[MENT OF CONDITIONS <br /> ��he undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett Irom any and all claims for damages, costs. <br /> ezpenses, or causes ol action that may arise 6ecause ot installation <br /> and m�intenance of the improvement or other right-of-way use hereto <br /> oved o on ction Date applietl lor and ��rther agrees to remove same upon notice irom the <br /> City and to replace pubGc E operry damaged there6y. <br /> ///�J � ,/f �J / �p <br /> F�NAL INSPECTION Date /�(1/ -� �C (��f�( �� z Z G'�> <br /> Approved as Constructed Sh,7n�iGre of Appli nt Date <br /> everett PUBIIC WORKS DEPARTMENT WORK AUTHORIZCD BY TIiIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND 7HEREAF7ER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE <br /> Phone:259�8810 CANCEL:.ED BV THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJ[CT OVER 90 DAYS DURATION. <br />