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\ � I <br /> 7 �9 ' <br /> Date�� Fu�bc Works Permil• I ✓ � <br /> Application For eme-oeo�.• 1'�-7 � <br /> PUBLIC WORKS PERMIT °°'°°"'°�k°`°a ' <br /> Total Fee s <br /> Less Aoo�Fee PaiO � �� � <br /> � Balence Oue S -� � <br /> Print or Type Only <br /> I� <br /> ner Mailing Address � City Zip Phone � <br /> IZabPr� �0 ��G a.�OG �po�n�1�c� /��nraP C�)/19r4d 7� 7�y-�i� �S �I, <br /> Applican� Mailing Addre City Zip Phone <br /> Describe Proposed Work ^ ,II��� P X� C � N�(q.��L/(il[1��C �� 1 C/�1 O J <br /> \ . ./ I <br /> 1� W <br /> Project Address(if known� �� a� '�--'� � �1 � � <br /> Attach four j4)copies M plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerline o(street � <br /> • Outline and dimensions of all existing and • Indicate North I <br /> �roposed structures on the lot • Show any proposed grading changes <br /> • lxisting and proposed utilities • Show measurements /M <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS O <br /> 1. All calls for inspection shall be made 24 hrs. in advance•phone 259•881 5. � ' <br /> 2. All work shall 6e performed in accordance with this permit and current Ciry of Everett Design antl Construction : <br /> Standards and Specificationa �, <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBER 1•800•424•5555. � �, <br /> PE�' Af'�,�ovF� Dk'f1�„dc-- v9r�o �/���� O <br /> � <br /> � <br /> � <br /> a <br /> ACKhCWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm• <br /> less the City ol Everett from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of inslallation <br /> � and maintenance ol the improvement or olher right•ol-viay use hereto <br /> '� applied for and turiher agrees to remove same upon notice trom the <br /> Approved or Construc ' ` Date City and to replace public property damaged thereby. <br /> 9 z � 7 �• ��1����� /� <br /> FINAL INSPECTION Date <br /> Approved as Constructed ignature of Applicant Uate <br /> WORK AUYHORIZED BY THIS PEiiMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 OAYS OF DAT[ PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Everett,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-8815 pROJECT OVER 90 DAYS DURATION. <br />