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����� �_Q Poblm Works Permil+ � <br /> Date1�LU� � <br /> eie9.ono�.�• � <br /> Application For <br /> PUBLIC WORKS PERMIT PubTotlFeeFee s __ � <br /> less ApD�Fee PaiO S <br /> Balance Due S I <br /> Print or Type Only I <br /> ,5.1�.�1c,�1���� �� Pr �� �vc�� `�cx�� 1�2�1 a�- , <br /> Owner Mailing Address City Lp Phone <br /> II <br /> l�� 1 ('a`�1.5��'h� i�7 n1D /�v� /�l� � � l L��/f�, �.8Q�5 <br /> Applican� Mailing Address City Zip Phone <br /> Describe Proposed Work ��� <br /> — I <br /> � <br /> � __ W � <br />, Prolect Address(if known) � <br /> Atlach four(4)copies of plans for proposed work-Draw to scale and note the following as applicable: � <br /> � Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing and i Indicate North <br /> proposed structures on ihe lot • Show any proposed grading changes <br /> • Existin9 and proposed utili�ies • Show measurements M <br /> W <br /> DO NOT WRITE BELOW TH�S LINE O <br /> PERMITCONDITIONS <br /> 1.All calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be peAormed In accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specificalions. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> �csr r���' � �.s�8 O <br /> �;� � <br /> � <br /> O <br /> a <br /> AGKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- . <br /> less the Cily of Everett from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because ol installation � <br /> and maintenance ol the improvement or other righFof-way use hereto <br /> applied lor and further agrees to remove same upon notice from the <br /> Approved for Construction Date City and to realace public property 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 PUBLICWORKSOEPAFTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAF7ER IS TO <br /> � 3200 Cedar Sireel BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOfiK ON THIS <br /> Phone:259-8810 PFOJECT OVER 90 DAYS DURATION. <br /> . <br />