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Date�-��� ,'� ��' Pubhc Worhs Pe�mi <br /> � � I Bing.Deo��+ ����— <br /> Applicatio�� For I , <br /> PUBLIC WORKS P�RMIT � °°°°°W°��5��� --- '! <br /> Tota�Fee S— <br /> Less Apal.Fne Van1 S � <br /> �a:nnr,p Du�� S_ , <br /> Print or Type Only — <br /> � �-���"/'1 �1�`J/� <br /> Owner Maihng Address Giry Zip Phone <br /> Apphcam Mailing Address City �ip Phone ' <br /> Describe Proposed Work I�' " � �' ��"�=-` ���/ ��1 <br /> — �< _��d <br /> C.�7f�� <br /> , � W <br /> Proiect Address i!� known) _ � , �. <br /> Attach four(4) copies c,f pians for proposed wo�k- Draw to scale and note the tollowing as applicable: �P1 <br /> • Property Lines • Centerline of street � , <br /> � • Outline and dimensions of all existing and • Indicate Norih <br /> proposed struc�ures on the lot • Show any proposed grading changes <br /> • Ezisting and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls for Inspection shall be made 24 hrs.in advance-phone 259-8810. �\ <br /> 2.All�vork shall be performed in accordance with this permit and current City of Everett Design and Construction ♦ <br /> Standards and Specifications. <br /> 3.Call Location Undergrour.d Service 48 hrs,before you dig.TOLL FREE NUMBER 1-800•4245555. � <br /> Illd l '�� , 0 <br /> `��/ /��t-// <br /> � ��,��, <br /> H <br /> � <br /> O <br /> a <br /> ACKP'JWLEDGEMENT OF CONDITIONS <br /> The undersigned ov,ner/applicant hereby ayrees lo hold and save harm- <br /> less the City of EvereU from any and all claims for dam3qes, costs. <br /> expenses, or causes of action that may arise because ot . .�tallation <br /> and maiNenance of the improvement or other rishl•of-way use hereto <br /> ---. applied for and further agrees to remove same upon notice from the <br /> Approved for Consiruction �a�e City and to replace public property dar�aged thereby. <br /> FINAL. INSPECTION Date <br /> Approved as Constructed Slgnature ol Applicant Dale <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 7g0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERM�T MAY 8E <br /> Everett,WA 98201 CAMCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAYS DURATION. <br />