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Date.� � Publle Works Permll• <br /> ApplicatlonFor eiao�oeo�.+-9' _ <br /> PUBLIC WORKS PERMIT PUOIicWorksFee <br /> Total Fea 8 <br /> Lesa AqpL Fea Pa10 S <br /> Balence Due S <br /> Print or Typs Only <br /> Q.rwC�to'� /9 S''�1`rf-'a 3> <br /> 4��Gn�Gir�-i /o � � ���d� ,P�. �' 1��o�'e-. �Pl� <br /> i ��''�� � Owner Mai4ing Address Ci Zip P e j3 <br />� I <br /> I i , <br /> C���v�l <br /> I . '� Applicant Mailing Address Ciry 7.ip Phone , <br /> i �����t� <br /> i - � Describe Proposed Work <br /> � <br /> � — <br />� j:' W <br />� � Project Address(if known) � �� � � � <br /> ` Attech four(4)copies of plans for proposed work- Draw to scale and note the following as applicable: � <br />� �Ei %f,, . • Property Linea • Centerline of street � <br /> �:� +>.- � • Outline and dimenslons of all existing and • Indicate North <br />{ ;,�, :!;j,-. � proposed structures on the lot • Show any proposed grading changes <br /> 'r ii�`����: . � • Exlsting and proposed utilities • Show measurements � <br /> � ' . I DO NOT WRITE BELOW THIS LINE <br /> � � PERMITCONDITIONS O <br /> 1.All calls for Inspection shall be mede 24 hra in ed�ance-phone 259�8810. � <br /> 2.All work ahell be performed in axordance with this permit and current City oi Everett Deaign and Construction <br /> �� Standerds and Speclficatione. <br /> 3.Call Lxation Underground Service 48 hra before you diy.TOLL FHEE NUMBEX 1-800�4245555. � <br /> O <br /> ,���� w�- ��'-�� ,�P�..,..�.� � <br /> �. 5� 23 - 9 � V� <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages, costS <br /> - expenses, or causes of action that may arise because of installation <br /> and maintenance ot ihe improvemenf or other dgM-of-way use hereto <br /> applied for and further agrees to removt ,eme upon notice from the <br /> Approvea for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> � � PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BF. STARTED WITHIN <br /> 3200CederStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TU COMPLETION.THIS PERMIT MAY BE <br /> CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> , Phona:259-8870 PROJECT OVER 90 DAYS DURATION. <br />