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Date ��✓ �� ^ Puld�c wmks Pmpmi1� <br /> AppliCalion For o�aB ��ou�.• C2—� <br /> PUBLIC WQRKS PERMIT PuEi�cWorksFev <br /> TOIRI F9C � <br /> lev npa�Poe P.ia S <br /> Print or Type Only o��a�:e o�a s <br /> BEt�,e� ��b� . � i1/,� �. Y'�' ��c�1�1 n���3 ".�-�� <br /> Owner Mailing AdAress City Zip Phone <br /> 6�,+� — <br /> Applir.ant Mailing Address City Zip Phone <br /> Describe Proposed lNork C��ST�UGT aMC'L',�' <br /> Project Address(il knownl ���!T �•S�U/V� ►!✓ � <br /> Attach four(4)copies o1 plans!or proposed work• Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> � O�tline and dimensio�s of all existing and • Indicale North <br /> proF�ged structures on the lot • Show any proposed grading changes <br /> • Existing and proposad utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> t. All cells for inspection sha�l be made£a hrs in�dvence• phone 259•8815. � : <br /> 2. All wo�k shall be performed in accordance with O�is permit and current City of Everett Design and Consiruction <br /> Star�derds and Specilications. <br /> 3. Call Location UndergraunA Service 48 hrs. betore yau dig.TOLL FREE NUMOER 7•800•424•5555. � . <br /> /f/o PliBci� wo�ts' f�{,�mrr �Ew�•,eE'.d 7-23-g7 0 <br /> ���� � <br /> � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CIiiJUITIONS <br /> The unCcrsigned owne�/applicanl hereby�nre�es to hold and save harm• <br /> — less the City ol Everett from any and all claims lor dameges, costs, <br /> expenses, or causes of act�on :hat may arise because of installation <br /> and maintenance ol ihe improvement or other righFof�way cSe hereto <br /> applied for and further agrees to remove same upon notice from the <br /> Approved ior Construction Datc City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Conslruded Signature of Applicant Date <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Siree� 180 DAYS OF DATE PERMIT IS ISSUED AND fHEREAFTER IS TO <br /> Everett,WA 98201 BE DILIG[NTLY PURSUED TO COMPLETION. THIS PERMIT MAY DE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE QF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />