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D�t@.11_L�2-� Puoiicwo�xsaeime' .�"" '� "f� <br /> Bltlg.Dept.a��� <br /> Application For <br /> PUBLIC WORKS PERMIT PU�Ta1nIFesFee 5 <br /> Less Appl.Feo Paitl S <br /> Balancc Duc 5 <br /> Print or Type Only <br /> �� �',I a��r�'1 G'al5 � � ��C �Sk.=_��il��' �'�-��7 <br /> Owner Mailmg Address City 7�n Phone <br /> �p� �n �3��p1.f�v�5_-���.5�3 �3 92"18 <br /> � ading Address City Zip Phone <br /> Describe Proposed Work � �� —� <br /> W <br /> Project Address(if known) � V � � i <br /> Attach 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 existin9 and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes ' <br /> • Existing and proposed utilities • Show measurements M li, <br /> W <br /> DO NOT WAITE BELOW THIS LINE O �i <br /> PEHMIi CONDITIONS � <br /> t. All calls for incpeclion sh�ll br, made 24 hrs. in advance- phone 259•881 5. � �,, ��. <br /> 2. All work shall 6e performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications ' <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � , <br /> ii <br /> !`���G.G �vo%�,�c f��,�m�T �tIGT .�Et`.�ciii�E.0 8-3-c97 O <br /> ��� ��A <br /> V♦ <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everett from any and all claims for damages, costs, <br /> expenses, or causes of acUon that may arise because o( installation <br /> and mainlenance of the improvement or other right-of-way use hereto <br /> applied for and furiher agrees to remove same upon notice from the � <br /> Approved (or Construction �a1e City and lo replace public property damaged lhereby. � <br /> I <br /> i <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date I <br /> WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN � <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEFl IS TO � <br /> � 3200 Cedar Sireet BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE � <br /> Everett,WA 98201 CANCELLED BY ThIE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259-8815 PROJECT OVER 90 D.9Y5 DURATION. <br /> �� <br />