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--� Publlc Waiks Pmmit a V /� <br /> D'n?2- � � --I Y- <br /> BIEg DnpL• ' " <br /> Application For /l„an t �r� ��I��]��_ <br /> N// <br /> r���IrJ WORKS PERMIT ruOTo�FeeFee 5 <br /> Less Appl.Fee Paitl � <br /> Balance0ue $ ZQOO <br /> Print or Type Only <br /> � /� '� L. � V / e��_ 11�� � <br /> Owner Mailing Add:ess � City Zip Phone <br /> �ai��F -- — <br /> Applicant Meiling Address City Zip Phone <br /> Describe Proposed Work � �r� �-����r� C��� l. � ���� <br /> � <br /> Proiect Address(if Icnown) '7���A �a � /`3�h'ST � �. <br /> Attach four(4)copies of plans for proposed worh• Draw lo scale and note the following as apP���able: �� � <br /> w Property Lines . • Centerline of street � <br /> o Outline and tlimensions of all existing and • Indicate North <br /> pro�osed strucWres on the lot • Show any proposed grading changes <br /> • E��s!;�g and proposed utilities • Show measurements M . <br /> W <br /> . DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1, All calls for inspectioi�shall be made 24 hrs. in advance- phone 259•881 5. � � <br /> 2. All work shall be perlormed in accordance with this permit and current City of Everetl Design and Construction <br /> Standards and Specifications. <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FFEE NUMBER 1-800•424•5555. � <br /> � <br /> � <br /> � <br /> �1I <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> ��e The undersigned owneUapplicant hereby agrees to hold and save harm- <br /> --.— �— less the City of Everett from any and all claims tor damages, costs, <br /> expenses, or causes of action that may arise 6ecause of irstallation <br /> -�(�� �/ and maintenance of lhe improvement or oiler righbohway use hereto <br /> �/ !/Z�i��Oz>�.�-• y �- L applied tor and further agrees to remove same upon notice trom :he <br /> Approved fo�Constructio Date City and to replace public properry damaged thereby. <br /> �`f/ � o�G �� �� - l �' ��'� S��� <br /> FlN4L IMSPECTION Date L^"-` � " <br /> Ap;aoved as ConsLucted �Signature ot Applicant Date , <br /> WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED INITHIN <br /> everelt PUBLIC 4VORKS DEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200 Cedar Street BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MpY BE <br /> Everett,N/A 98201 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phone: 259- ��sgS� PROJECT OVER 90 DAYS DURATION. <br /> �� � <br />