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<br /> Applieation For em�.oe:a.. _- _ f � _
<br /> PU �LIC V100RKS RERMIT �°°�°°W°«sF�� S�yz=
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<br /> Owner Madmg Address City Zip Phone ���
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<br /> Applicant Mailing Atldress C�t Zip Phone ��
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<br /> Describe Proposed Work Y'— _ _ �II
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<br /> Projecl Address(il krownl ���� � J 7��_:�� _ � . �
<br /> P,tlach four 141 cop�es of plans for proposed work- Draw to scale and note the following as anPlicable� �- .
<br /> �
<br /> • Property Lines • Centerllne ol siree� (9 � .*
<br /> • Outline and dimensions of all existing antl • Indicate Nor�h � � ..\ i�
<br /> proposed structures on ihe lot • Show any proposed grading changes '
<br /> • Existing and proposed utilities • Show measurements 9 ,_ , �'
<br /> DO NOT WRITE BELOW THIS LINE �`
<br /> PERMITCONDITIONS `��,• � .�
<br /> 1.All calls for inspection shall be made 24 hrs.in advance- phone 259•8810. ��� . `'
<br /> 2.All work shall be pedormed in accordance with this permit and current City of Everett Des�gn and Construction , ���:
<br /> Standards and Specifications.
<br /> 3 Call Location U�derground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424-5555. � '
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<br /> ACKNOWLE�GEMENT OF CONDITIONS �I�
<br /> The undersi9ned ownedapplicant hereby agrees to hold and save harm- �
<br /> / less the G�y ol Evere.tt from any and all claims for damages. cosis.
<br /> � / �-- �i�� expenses, or r_auses of action that may arise because of installalion
<br /> ,�J ' and maintenance of the improvement or other righ4oi�way use hereto
<br /> '� `� — applied for and furiher agrees tu remove same upon notice Irom the �,
<br /> Ap ruved for Cp str Da�e City and tq-r�Tp ce puhGc properry damaged thereby.
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<br /> FINAL SPECTION Date / / ' "� �—/ 5�
<br /> Approved as Consiructed ign� re of AppGcan� Datc
<br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAH7ED WITHIN
<br /> �80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO
<br /> � 3200CedarStreet 8E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT �v1AY BE
<br /> EveretC WA 98201 GANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS
<br /> Phone:259�881J pROJECT OVER 90 DAYS DURAlION.
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