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Date�$" � � Publ¢Works Permit a _ <br /> , � � - �c. <br /> Application For eia9.oaoi.•—n c` ��I I� <br /> PUBLIC WORKS PERMIT PublicWorksFae -- <br /> Total Fee $ <br /> Less AoO�.Fee Paid $ <br /> Print or Type Only ea�a��e o�e s <br /> �.�i.A1�W�ftcr�.., r,2�3id -d:��aLJ'/-.� F—✓nint� ��Pza/ ZSz_ �Is�r <br /> wner Madmg Address Cdy Lp Phone <br /> �. � b.��-f. �� Y�c� - ���,,,� Do f�� �,,e�tl QRz�� <br /> Applicant Mading Address City ZiT�p phone <br /> / � `/ <br /> : Describe Pronosed Work �N,�y�l ua( b�r�;� �(�G(. P.�rJ�J.�f��Qi <br /> W <br /> Prolect Address(if known) a a - �.., <br /> Attach four(4) copies ot plans ior proposed work- Draw to scale and nole the following as applicable: � <br /> , s Property Lines • Centerline of sireet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> ' proposed structures on ihe lot • Show any proposed grading changes <br /> - • Existing and proposed utilities • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> . 7.All ca�ls for inspection shall be made 24 hrs.in advance-phone 259•$$10. � <br /> 2.All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Localion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-500-424-5555. � <br /> O <br /> ��,��,G Cl����..o/l���it>o�,�e��� ,� � <br /> `� " 3-88 � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City o� Everett Irom any and all claims lor damages, cosis. <br /> �. expenses. or causes ol action that may arise because of installation <br /> and maintenance of Ihe improvement or other righPol�way use hereto <br /> � applied for and lurther egrees to remove same upon notice from the <br /> Approved for Conslruction Date City and to replace public properry damaged ihereby. � <br /> FINAL INSPECTION Oate . <br /> 4pprovrd as Con&tructed Signature of Aoplicant Date �� <br /> �ev�rett PUBLIC WORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN ' <br /> 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E �'� <br /> Everett,WA 98201 CANCELLED B'f THE CI7Y UPON ANY STOPPAGE OF WORK ON THIS ; <br /> Phone:259-8870 PRpJEC?OVER 90 DAYS DURATION. � <br /> � <br /> . � <br /> � <br /> i <br /> ti <br />