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i <br /> Date�:,-`�f�/��� W�` ���� — <br /> Pu�Oc WaMs Per I <br /> Appiication fcr Bltlg Depl.+ �_ _ <br /> PUBLIC WORKS PERMIT Pu�TotalFeeFee $ -- <br /> Less AOP�Fee Paid 5 <br /> Oalnnce�ue $_ <br /> Print or Type Only <br /> ��� 1��c��!2i�lCi'� � ► ��3 I Q � ���_ 5� . <br /> Owner Mailing Address City Zip Phone <br /> ��All� <br /> z-ov-- <br /> Appiicant Me'ling Address City 2ip Pha <br /> � <br /> Descrite Proposed Work ��Q�� F--� �� �' `��- ������ — <br /> Proled Address(il known) �� �— – � <br /> � <br /> Attach four(4) copies of plans lor proposed work- Draw to scale and note ihe(ollowiny as applicable: � <br /> • Property I_ines • Cen�erline of street � <br /> • Outline and dimensions��f nll exisling and • Indica�e Norih <br /> propcsed structures �n the lot • Show any proposed grading changes <br /> • Exislin9 and propoeed Wi�ities • Show measurements � <br /> �� <br /> DO NOT WRITE BELOW THIS LINE � <br /> PERMIT CONDITIONS <br /> 7.HII calls for inspection shall be made 24 hrs.in advance•phone 259•8810. � <br /> 2.All work shall be peAoimed in accordance with this permit and current Cily oi Everetl Design and Construction <br /> Stanaards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> / �� O <br /> V_ � � � � <br /> I�' ° � � <br /> /� O <br /> � a <br /> ��` ����� � <br /> � <br /> //"/� ACKN WLEDGEMENT OF CONDITIONS <br /> /The undersigned ov� er/applican�hereby agrees to hold and save harm- '� <br /> less the City of Everett irom any and all claims for tlamages, costs, , <br /> expenses, or causes of action that may arise because of installation <br /> and maintenance ot the imorovement or olher ric�ht-o4way use here�o �, <br /> appli?d for and turther agrees to remove same upon notice from the ��, <br /> Approved lor Construction Date City and to replace public property damaqed thereby. <br /> FINAL INSPECTION Date — � <br /> Aporoved as Construcled Signature of Applicant Date <br /> WORK AUTHORIZED BY THIS PEfiMIT MUST B'c STAFTED WITHIN � <br /> evereu FUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO '� <br /> � 320o Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. TH!S PERMIT MAY PE , <br /> EverelL WA 98201 CANCELLED BY THE CITY UPON HNY STOPPHGE OF WOFK ON THIS <br /> Phone:259-8810 PROJECT OVER 90 DAVS DURATION. , <br /> i <br /> i <br /> �+ <br /> 1 <br />