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Date `�'�_v� Pu�lic Works Permlt• <br /> Applica:ion For eie9.oePi..� <br /> PUBLIC WORKS PERMIT PuClicWoiksFee <br /> To1a1 Fee $ <br /> Less Appl.Fae Paltl S <br /> Print or Type Only ealanca Dua a <br /> ��� K. t��v�e�-rr� ��_i�� ���'A v� sr- Ev�-rr 9��/ <br /> Owner Mailing Address City Zip Phone <br /> ..�m F <br /> Applicant Mailing Address City Zip Phone <br /> Describe Proposed Work L���.r�' I At� rl� �� �y� ,�\I <br /> Project Address(it known) 0�0�-�J � � <br /> Attach four(4)copiec 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 a!I existing and • Indicate North <br /> proposed structures on fhe lot • Show any proposed grading changas <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CON�ITIONS O <br /> 1. All calls for inspection shall be made 24 hra in advance- F�hone 259•881 5. � <br /> 2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specificationa �. <br /> 3. Call Location Urderground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800-424-5555. � ; <br /> �j / I <br /> /�U6'G/C- �-��.�5 f-'�F.E'ini i" iL(�JT" iPE'Ci'U.i.E?E'Q y3� 7 O i <br /> �(� ' <br /> � 4 � <br /> I <br /> � <br /> O <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS '� <br /> The undersigned owner/applicant hereby agrees to huld and save harm- i <br /> less the City of Everett trom any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because oi installation <br /> and maintenance ol ihe improvement or olher righPof-way use hereto <br /> Approved for Construction Date app11ed for and fur�her agrees to remove same u�on notice from the <br /> City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Dafe <br /> e+erett PUBLIC WORKS DEPARTMENT H'ORK AUTHORIZED 6Y THIS PFRMIT MUST BE STARTED WITHIN <br /> � 3200CedarStree� 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO �. <br /> Evere�t,WA 98e01 BE D�LIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE ''� <br /> Phone: 259•8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF'N'ORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />