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Date��q ,^� ,..._. �„�����.��o,.,P,. . ' '� r <br /> Appli�alion ror �ihq oeai. . r ��i�. <br /> —__ T ' 1 ._ <br /> PUBLIC WORKS PEFiMIT ��bLCWo�YSFee --- <br /> ,o�a�F�� �— <br /> Less Anol.Fee Pa�o S _ <br /> Print or Type Only �d���Ce oue $ <br /> I�'GY�� �1 ��C`��"�� ��� �(� �'� �aYCY� <br /> ��wner �— Mading Adtlress City Zlp Phone <br /> Applicant Mailing Address Clty Zip Phone <br /> ��—�j i <br /> Describe Proposed Work <L�c -�— <br /> Pro�ect Address lif knownl � � �. �� , � <br /> � <br /> Attach four(4�copies ol plan5 for proposed work- Draw to scale and note ihe lollowing as applicable: � <br /> • Property Lines • Cen�erline ol street � <br /> Y Outline and dimensio.is ol all exi5ting and • Indicate Norih <br /> proposetl structures on Ihe lot • Show any proposed grading changes <br /> • Existing and proposed Wilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br />� � PERMITCONDITIONS <br />- � � 1.All calls for inspection shall be made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and current City ot Everett Design a�id Construction <br /> Standards and Specifications. <br /> � 3.Call Location Underground Service 48 hrs.before you dig.TQLL FREE NUMBER 1•800•424-5555. � <br /> l�..ot ��� . ��� p <br /> a� �� e9 � <br /> � <br /> � <br /> � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> Thf���ndr,�sr._.��red owner/applicant hereby agrees to hold and save harm- <br /> less tY��e City of Everet� from any and all claims for damages, cos�s. <br /> expenses, or causes ot action thal may arise because of installa�ion <br /> and mainlenance ot the improvement or other right•of•way use hereto <br /> applied for and furthcr a9rees to remove same upon notice Irom lhe <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPECTIO�' Date <br /> Approved as Constructed Signature ol ApplicaM Dale <br /> everett PUBLIC WORKS DEPARTMENT WOFK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF DAT� PERMIT IS ISSUED AND THEREAFTER IS T� <br /> Everet4 WA 98207 BE DILIGENTLY PURSUED TU COMPLETION. ?H;S PERMI7 MAY BE <br /> Phone:259�8810 CANCELLED 'iY THE CIT"UPUN ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />