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r-. --- <br /> 7 �� / w PUG6c Wurks Permit Y <br /> •��Y.:' ���.`1L- <br /> Date.— r <br /> eiee.o�oi.• <br /> Application For _ <br /> PUBLIC WORKS PERMIT '°°ro,aFeoFee $ <br /> i <br /> Less Appl Fee PaiO $ .3f <br /> Balance Due $ ; <br /> Pri�t or Type Only �+ <br /> ('�� ,alr�' �- h��hblPs (JP�a�� ll ao ��x 5�3b C✓�iZN �j�fZa6 Phz59-al14 � <br /> Owner Ma�ling Address City � <br /> a <br /> S C'iVl� �— � Z{p Phone <br /> Applicant Mailing Address City <br /> Describe Prop�sed Work <br /> W <br /> Project Address�if known) � �(`�' - � }k � � <br /> � <br /> Attach four(4)copies ot plans tor proposed work• Draw tc scale and note ihe tollowin�as applicable: � <br /> • Property Lines . • Cenlerline of street <br /> � Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements M <br /> W <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. AI�work shall be per(ormed in accordance with this permit and current City oi Everett Design and Consiruction <br /> Standards and Specifications. � <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. <br /> y O I <br /> ���-r'i GlJG2I�� S��i�w� �G��-Gy�-cG-� ///-/O'c'�% <br /> V c.�C��.� � <br /> �f" � <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 (rom any and all claims for damages, costs, <br /> expenses, or causes ot aclion that may arise because of instal�ation <br /> and maintenance ol the improvemenl or other right�of-way use hereto <br /> applied for and furlher agrees to remove same upon notice from the <br /> Approved for Construction Date City and to replace public property damaged thereby. <br /> FINAL INSPE�TION Date Date <br /> Approved as Constructed Signature oi ApPlicant <br /> WORK AUTHCRIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> everett PUBLIC WORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar S�reet BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Everett.WA 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone:259�8875 PROJECT OV[R 90 DAYS DURATION. <br />