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Date�� Pu�lic Worka Permit+ �� � � — <br /> BIEB.Dept• � O <br /> Application For <br /> PUBLIC WORKS PERMIT PUOTaaIFaeFee $ � no <br /> Less Ao��.Fee PaiO S �— <br /> Ba�anca Due S ��� Q � <br /> Print or Type Only <br /> //�� �js��� S6 �' . SL3� <br /> � � � �,�� Ma�dress City Lp Phone <br /> Owner 9 <br /> ' qPP� Mailing Address Ciry Zip Phone <br /> I <br /> Describe Proposed Work ����3 <br /> W <br /> . ,� �� � <br /> Prolect Address(if known) �G V <br /> Attech four(4) copies of plans for proposed work- Draw to scale and note the following as applicable: � <br /> � Property Lines • Cent=rlin=o(street � <br /> • Outline and dimensions of all existing and � Indicate North � <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M , <br /> W <br /> DO NOT WRITE �ELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Desi�n end Construction � <br /> Standards and Specifications. "= <br /> 3. Call Location Underrnswia Service 48 hrs. Gefore you dig.TOLL FREE NUMBER 1-800•424•5555. � � <br /> �r <br /> O <br /> � ~~.] r~.-� <br /> � N H � <br /> � � <br /> d � � <br /> � <br /> a K <br /> � �� <br /> � � <br /> � <br /> � �, <br /> ACKNOWLEDGEMENT OF CONDITIONS y � <br /> The undersigned owner/applicant hereby agrees to hold and save harm- K <br /> _ less the City ol EvereU from any and all claims for damages, co�ts, p �� <br /> � expenses. or causes �f action that may arise because ot installation "7 `r,: <br /> ^ - �_ � „f and maintenance of the improve��nent or other right-of-way use herero °� <br /> applied tor and further agrees lo remove same upon notice (rom the � ,., <br /> Date City and to replace public property dama9ed lherehy. °� <br /> proved tor Construction � <br /> � -- .i/� <_� � <br /> �/�-(L��� � 1`�-� y G f i <br /> . l f � �. <br /> FI ALINSPECTION Date � � � �� � Date �� <br /> Approved as Construct�.: Signature of Applicant � 4� <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> evere[t PUBUC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THfREAFTER IS TO `� <br /> � 3200 Cedar Slreel BE DILIGENTLY PURSUED TO COMPLE710N. THIS PEFiM1T MAY BE <br /> Everelt.WA 98201 CANCELLE� BY THE CITY UPON ANY STOPPAGE OF WORK ON 7HIS <br /> Phone: 259•8815 PROJECT OVER 90 DAYS DURA710N. <br />