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i / <br /> Date .��� _, <br /> ' PubLc Wo�ks Per �y <br /> 1 - —. <br /> AppliCa�iCn Fof Bltlq Depl.s <br /> PUBLIC WORKS PERMIT Pu�ToiTFeeFee s -- <br /> 1055 Ap01 FEP Pdrt� .� <br /> Print or Type Only ea�r��e o�� a <br /> �q� A ,� �+���,n �2�5r� <br /> uwner Mailing Address <br /> City Zip Phone <br /> Applicant Mailing Address <br /> City Zip Phone <br /> Describe Proposed Work TPYI� �T Trnn <br /> �A��'1 /-��l�n_17� -7� r7-� <br /> Project Address(il knownl "� � � � <br /> Atfach lour(4�copies of plans lor proposed work- Draw lo scale and note the following as applicable: � <br /> � Property Lines � Centerline of street <br /> • Outline and dimensions ol all existing antl • Indicate North � <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements <br /> DO NOT WRITE BELOW THIS LINF � <br /> PERMITCONDITIONS O <br /> 1.All cells for inspection shall be made 24 hrs.in advance-phone 259-8810. <br /> 2.All work shall be peAormed in accordance with thi;permit and current City of Everett Design and Construction ' <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-g00-qQ4•5555. <br /> � ,�� Z <br /> �y���� o <br /> � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersignetl owner/applicant hereby agrees to hold and save narm- <br /> less the City of Everett from any and all claims for damages, costs, <br /> expenses, or r,auses of action that may arise because of installation � <br /> and maintenance of Ihe improvement or other righbof-way use hereto <br /> Approved lor Construchon Date applied for and furlher agrees to remove same upon notice 'rom tha ' <br /> i,ity and to replace public property damaged thereby. <br /> i <br /> FINAL INSPECTION Date � <br /> ApGroved as Construcfed Signalure of Applicant — 1 <br /> Date j <br /> everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN � <br /> � 3200CedarStreet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA g8201 BE DILIGENiLY PURSUED TO COMPLETION. THIS PERMIT MAY BE j <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS ' <br /> PROJECT OVER 90 DAYS DURATION. ,� <br />