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/ � Pu01ic Woiks Pe�mit• :i <br /> �BiB_���U � BiaV.DeGt.r��/ 7.J i 5� <br /> Application For <br /> PUBLIC WORKS PERMIT '�°:o,eFeeFee a <br /> Lesa�Da� Fee PeiE S <br /> Balance Duc s <br /> Print or Type Only <br /> �O <br /> �oi �i ��,��e 9�aa � y�� - %�� <br /> � UP/A� �nd1N/uHi�1 Ma^n ddress City Zip Phone <br /> Owner T <br /> d �dC � � � ���Y ;p phone <br /> A plicant Mailing Address <br /> Describe Proposed Work <br /> F II �� n�pn �c� ��nn� ST»re� (� P�«� f <br /> �_�_�j(�cy� I� ��� l rJ��� — <br /> W ; <br /> Project Address(if known) � <br /> — �I <br /> Attach four(4)copies of� lor proposed work- Draw to scale and note tte following as applicable: � <br /> • Property Line. �� Centerline of street <br /> • Oulline and dimensions of all existing and �� Indicale Norih <br /> proposed atructures on the lot • Show any proposed grading changes <br /> • Existing and proposed ulilities • Show measurements M <br /> W <br /> DO NOT WRITE BEIAW THIS LINE O <br /> PERMIT CONDITIONS � <br /> 1. All calls for inspection shall be made 24 �:rs. in advance-phone 259•881 5. <br /> 2. All work shell be pertormed in acwrdance H�ith ihis permit and current Ciry ot Everett Design and Construction <br /> Standerds and Specifications. � <br /> � 3. Call Location Underground Service 48 hrs.belere you dig.TOLL FREE NUMBER 1•B00•424•5555. <br /> /VO' �/��"iPm�— .�e=Q • O <br /> /�� ��j�� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicanl hereby agrees to hold and save harm- <br /> — less the City ol Everett irom any and all claims �or damages, costs, <br /> ezpen:es, or causes ol action that may arise because of installalion <br /> and maintenance of Ihe improvement or other righFof�way use hereto <br /> epplied for and furiher agrees lo remove same upon notice Irom the <br /> Appmved for Consiruction �a1e Ciry and to replace public property damaged thereby. <br /> F!NAl 1NSPECTION Date Da�e <br /> Approvetl as Consiructed Signalure ol Applicant <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTP,1ENi 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street I BE DILIGENTLY PURSUED TO COMPLI:TION. THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br /> Phone: 259-f 315 PROJECT OVER 90 DAYS DURATION. <br />