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� rY�J <br /> Date -`r��'<' l `—� Pu�lic Works Permd> � <br /> Application For <br /> 010�.Deo�.+ �� ' ���=� <br /> PUBLIC WORKS PERMIT Pu�licWorwsFee <br /> totai Feo S <br /> Less Appl.Fee Paia S <br /> Balance�ue '2 <br /> Print or Type Only <br /> � ��' � � <br /> r�l 1�,�1�i�" ,!�=�'v� ;-��T _ 'r_C�'2�'.� 9.��3 ,'2���_�-�,`?S�. <br /> O�Nner Mailing qddress City Zip Phone <br /> _;i7�7�/1 <br /> Applicanl Mailing qddress City Zip Phone <br /> Desr,ribe Proposed Work _ �.����/��/T .� <br /> PrujeclAddress�ilknown) `'�J��CG /�'��� •_�l � <br /> � <br /> Attach four(4)copies of plans lor proposeC work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Centerllne of slieet � <br /> • Outline and dimensions of all existing anG • Indicate North <br /> proposed struclures on the lot • Sliow any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DU NOTVaHITE BELOW THIS LINE <br /> PERMIT CONOITIONS O <br /> t. All calls for inspection shall be made 24 hrs. in advance- phone 259•881 5. � <br /> 2. All work shall be perlormed in accordance with this pennit and currenl Giiy el Everett Uesign and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs. belore you dig.TOLL FREE NUMBE;t 1-800-424•5555. � <br /> �lJ���c l.Jo,�.�s �F.P�iT ,�/or �E���,e� � �8-B 7 � <br /> �,U",� � <br /> � <br /> � <br /> a <br /> ACKNOWLEUGEMENT OF CONDITIONS <br /> The undersiqned owner/applican�here6y agrees to hold and sav� tiarm- <br /> less ihe Cily of Everett irom any and all clai:ns lor damages, costs, <br /> expenses, or cause� ol aclion ihal may arise becauso of installation <br /> and maintenance of the improvement or other ri9ht�oFwey use nerelo <br /> Approved lor Construction Dale '��lied for and furthr.r aprees to remove same upon notice irom 11e <br /> City und to replace public prop?rty damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Cons�ructed Signature ot Applicont �ate <br /> everett PUBLIC WORKS DEPARTMENT 1hORK AUTNORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Slreef 1 d0 DAYS OF DA'fE PERMIT IS ISSUED AND THERF.AFTER IS TO <br /> Everett, \NA 98201 3E DILIGENTLY PURSUED TO COMPLET!ON. THIS PERMIT MAY BE <br /> Phone: 259�8815 CANCELLED BY THE CITY UPOIJ ANY STOPPAGE OF WORK ON THIS <br /> PPOJECT OVER 90 DAYS DURATION. <br />