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- <br /> L�ate�� � �-, '" Pu�bc Works Permil r <br /> Applica. .iFor 91EB.Oept♦ � �,� <br /> PUBLIC WORKS PCRMIT P�o°�W��k=Fea <br /> Totni Fee S <br /> �ess AOCI.Fau PaiO S <br /> Print orType Only Ba�a�=ao�e s <br /> �_��v��L ,�ri�L 5�n� a3�I �4��F�1. c��fi a�an� <br /> Ow�:er �— Mailing Address City 2ip Phone <br /> ��l�I� �l�'� (�-�'� f�- � �t��fi `�_ 3 3 7-�i�9 <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work �I�1L��`l��.s�(�I� �I�I�� ���nY�/lr=�� <br /> W <br /> Prolect Address(if known) __ � <br /> Attach four(4)copies of p�ans for proposed worh- Draw to scale and note the following as applicable: � <br /> , • Property Lines • Centerline of street � <br /> ! • Outline and dimensions of all existing and • li�dicate Narth <br /> � proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities � Show measurements � <br /> DO NOT WRITE BELOW THiS LINE � O <br /> PERMIT CONDITIONS <br /> 1. All ca'Is for inspection shall be made 24 hrs. in advance• phone 259-8815. � <br /> 2. All work shall be performed in accordance with ihis pennit and current City of Evere�t Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1-500•424•5555. � <br /> �JB�iG' u�o2,rts ,�E..�m�T �r/n� �'�4�/i�.-�d O <br /> /-,ZC�87 <br /> � <br /> � <br /> Q <br /> a <br /> ACKNOW'LEDGEMENT OF CONDITIONS <br /> The untlersigned owner/applic:.nt hereby agrees to hold and save harm• <br /> less the City of Everett from any and all claims tor damages, costs. <br /> expenses. or causes of action that may arise because of install,.�ion <br /> and maintenance ot the improvement or o�her right-of�way use hereto <br /> applied for and lurther agrees to remove same upon notice irom the <br /> Approved for Construclion Uate City and to replace public properry damaged therehy. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of.vpplicant Date <br /> evrrett FUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAHTED WITHIN <br /> � �200CedarStreet 780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTFR IS TO <br /> Everett,�VA 98201 BE DILIGENT�Y PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8815 CANCELLED BY THE CITY UPON ANY STi�PPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURA'i ION. <br />