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Date�k�S -.. -. <br /> Pu01ic Works Permit♦ <br /> Application For eiae�oeo� • 8S � `-�f(� <br /> . ��� <br /> � PUBLIC WORKS PERMlT PuoTotalFeeFea s <br /> Less AppL Fee Paid $ <br /> Print or Type Only BalancoDue e <br /> -��wu t � - Ca.�-�rcn� ,ZSi a - S/l� .(y .Fr�th�F/Luh` 9,��,i �,'S 9 -��� <br /> Owner Mailing Address City ' Zip phone <br /> �� � � <br /> o.;�plicant Mailing Address City Zip phone <br /> Describe Proposed Work ���,�r � �N�— ��rl C��y 6H���r{�S� <br /> ProlectAddress(ifknown) � C�S/c.Z. —��f� f� � <br /> Attach four(4�copies of plans for proposed work- Draw to scale and note the tollowing as applicable: � <br /> • Property Lines • Centerline of sireet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structu;es on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> 'rE?!:4!T SONDITIONS <br /> 7. All calls for i^�paction shali be made 24 hrs. in advance-phone 259•881 5. � <br /> 2. All work shall be performed in accordance with this pemit and current Gity 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 /> /�o PU�'G�C Zc,a�-�S� �',�-:�lT �'�'qai,el—'-� � <br /> �� 7���5 � <br /> 0 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- II <br /> less the Ci�y of Evere�t from any and all claims for damages, cosls, . <br /> ezpenses, or causes of action that may arise because of installation �� <br /> and maintenance of the impruvement or other righbof•way use hereto <br /> appiied for and further agrees to remooe same apon notice (rom the � <br /> Approved for Construction Date City and to replace public property damaged ihereby. <br /> FINAL INSPECTION Date <br /> Approved as Construr.ted Si�nature ol Applicant Date <br /> everett PUBi.IC V10RKS DEPARTMENT WORK AUTHORIZEO BY THIS PERMIT MUST BE STARiED WITHIN <br /> � 3eU0 Cedar Sireet 180 DAYS OF DA7E PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett, WA 98201 BE DII_IGEN7LY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone: 259-8875 CANCELLED BY THE CIIY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />