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Datei��),,�Q� r-•. ,,w..:, <br /> rL-l�-U 1 a�������wa,ks Pe,m„ <br /> em<� Dep�.• ' ��-- <br /> qpplicalion For � ��- <br /> PUBLIC WORK� PERMIT �u�TolafeeFec-� - <br /> Less Aopl.F>e Paia $ - <br /> Bolan,e Duu $ <br /> °rint or Type Only <br /> 1 Y�.YI�P (��'(��,�L <br /> W�ef M i ng Address Cdy Zip Phone <br /> Applicant Mailing.4ddress City Zip Phone <br /> Describe Proposed Work " � �«•- � �� ' <br /> - W <br /> Project Address(il knuwrp _�� H <br /> Attach four(4) copies ol plans for proposed work- Draw to scale and note the lollowing as applicable: � � <br /> • Properry Lir,es • Centerline of street � <br /> � Outline and dimensions ot all ezistiny��d • Indicate North <br /> proposed etructures on the lot • Show any proposed grading changes � <br /> • Existing and proposed uiilities • Show measurements � � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONUITIONS <br /> 1.All calls lor inspection shall be mnde 24 hrs.in advance•phone 259•8810. � <br /> 2.P.II work sball be performed in accordance with this permit and current City of Everett Design and Consiruction <br /> Standards and Specifications. � <br /> 3.Call Loca!ion Underground Service 48 hrs.before you diy.TOLL FREE NUMBER 1-800-424•5555. � <br /> � O i; <br /> h /%/!`'_. i��i <br /> � C` • f' <br /> �J/G�-J�'� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City ot Everett irom any and all claims for damages, costs. <br /> exDenses, or causes of action ihat may arise because of installation <br /> and maintenance ol ihe imVrovement or olher riyht-of-way use hereto <br /> applied for and further agrees to remove same upon notice from the <br /> Approved for Construction Date City and to replace public p�operry damaged there6y. <br /> FINAL INSPECTION Date <br /> Approved as Consiructed Signature ol Applicant Date <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLiCWORKSDEPARTMENT 1g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett.WA 98207 I CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-BB70 pROJECT OVER 90 DAYS DURATION. <br />