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i <br /> r <br /> �����/.�Q� PubLc WmYS P•L[u�l a /} -� � <br /> Date'�ti��L U I o��� odoi . ,-�(��((_,4��._ <br /> Application For ��` `� — <br /> PUBLIC WORKS PERMIT °°°°°`°°"sf�° ----- -- <br /> ,o�,�F�� 5_-- <br /> LessApCIFrtPPaW $ -- <br /> palanr.e Duc �u__ <br /> Print or Type Only <br /> ����'/I �_To___�—�-�L)��E�S �`1�3�� )���� �1 3�1'� `��C`�1 i <br /> Owner Mailing Address Gry Zip Phor�e . <br /> Applicant Mailing Addrer.s City Zip Phone <br /> Describe Proposed Work L--��' `�"� �J"' <br /> W <br /> Pwlect Address�if known� �� / � � <br /> Adach four(4) copies of plans for proposed work- Draw to scale and note the lol!owing as apUlicable: � <br /> • Property Lines • Genterline ol street /A <br /> • Outline and dimensions of all existina and • Indicate North V� <br /> proposed structures on Ihe lot • Show any proposed grading changes <br /> • Existing and proposed u�ihties • Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1.All calls tor inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordanc2 with this permit and wrrent City of Everett Design and Construction <br /> Standards and Specifications. <br /> 3.Cali Locztion Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. � <br /> (��� t�E�� � �'��vr� O <br /> 5-i —�9 <br /> � <br /> � <br /> � <br /> a <br /> ACKNOWLEDGEMENT OP CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City of Everelt Irom any and all claims lor damages, cosls. <br /> expenses, or causes ol action that may arise because of installation <br /> and maintcnance of Ihe improvement or other righl�of-way use hereto <br /> applied for and lurther agrees to remove same �pon notice from the <br /> Approved lor ConsVuction Date City and to replace public properly damaged Ihereby. <br /> FINA�_ INSPECTION Dale <br /> Aoproved as ConsVucled Sigr.aWre ol Applicant Date <br /> WORK AUTHORIZED 0Y THIS PERMIT MUST BE STNRTED WITHIN <br /> everett PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CedarStreet 8[ DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everetl,WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259-B810 PROJEGT OVER 90 DAYS DURATION. <br /> � <br />