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Date� v� PUEI¢Works Permit <br /> Application For aiae oeo��• <br /> PUBLIC WORKS PERMIT PueiicWoiwsFee <br /> total Fee S - <br /> less Appl.Fee Paitl g <br /> Baiance0ue $ <br /> Print or Type Only <br /> --�A11� P�—�ti�����1r� ia.� 19�� �4 v� S� ���u�� . <br /> Owner Maifing Address City Zip - Phone <br /> ����G� ,����`�(�, v �9 LTuri�� r� � � �y �-i�� <br /> Applicant Mailing Address�— CI� Zip Phone I <br /> Describe Proposed Work ��A ) ����_ I <br /> Prolecl Address(if known) VI � <br /> � <br /> Attach four(4) copies ot plans for proposed work- Draw to scale and nole the tollowing as applicable: � <br /> • Property Lines • Centerline ol Street � <br /> • Outline and dimensions ol all existing and • Indicate North <br /> proposed structures on the lot • E`�w any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS � <br /> 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � . <br /> 2.All work shall be pedormed in accordance wilh this permit and current City o(Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Serv�ce 48 hrs.before you dig.TOLL FREE NUMBER 1•$00•424•5555. � I <br /> / �/BCiC wo,�Cs f�2r��T �1loT .P.�'a7�i�,�Fb � O , <br /> a r6��a � ', <br /> � ''i <br /> O � <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS I <br /> The undersigned owner/applicanl hereby agrees to hold and save harm• � <br /> — less Ihe City of Everelt from any and all claims for damages, costs, <br /> expenses, or causes of action that may arise because of installation <br /> and main�enance of the improvement or o�her righbobway use here�o <br /> applied for and lurther agrees to remove same upon no�ice Irom the <br /> Approved for Construction Date Ciry and to replace pu6lic properry damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Cons�rucled Signature of Applicant Date <br /> everett PUBLIC WORV(S DFPARTME.NT WORK AUTHORIZFD BY THIS PEAMIT MUST BE STAR?ED WITHIN <br /> � 3200CetlarStrt:et 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br /> Phone:259�88�0 CANCELLED BY THE CITY UPON ANY STOPPAGL OF WORK ON THIS <br /> PROJECT OVER 90 OHYC DI IRATION. <br />