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3i .' ���.— s�� <br /> t� Public Warks Per 1 s � <br /> � �/ <br /> Application For em�.o�oi.r�L(� � <br /> '__ � <br /> PUH� �LIC WORKS PER�i11T Pu011cWarFSFce <br /> Tolal Fea � - <br /> Less AppL Poc Pairl S <br /> Bamnce Oue $ �� <br /> Print or Type Only <br /> �Q � � %�C`cfG�7��e��..n C>�? .( .YCJ 7l/�9 �( ��� �U�r-S� <br /> wner Mailing Address City �p Phone �� <br /> `'�\���__� � <br /> �1 <br /> Applicant Mailing Address City Zip Phone <br /> Uescribe Proposed Work _ <br /> �5��� i <br /> / �h W <br /> Pm!er.t Address 1'f knownl i l�'� / � / ��G�� — �� ,��i�. SE � � <br /> Attach four(4)c�pias of plans for proposed work- Draw to scale and note the following as applicable: � <br /> • Property Lines • Cente�line of etreet /^ <br /> • Cul�ine and dimensions of all exisling and • Indicate North V, <br /> proposed structures on the lol ! Show any proposed gra�no change�a <br /> • Existing and proposed utilities � Show measuremeats � ' <br /> DO NOT WRITE 6[LOIN THIS LIriE '� <br /> PERMIT CONDITIONS � li, <br /> 1. All calls tor inspection shall be made 24 hrs. in advance- phone 259-881 5. � i <br /> 2. All work shall t+pertormed in accordance with this permit acd curren'City of everett D^sign and Conslruction � <br /> Standards and .�ecifiwtions. �i <br /> 3. Cali Location Underground Service 48 hrs.before you dig.TULL FRE.E NUMBER 1•F�JO•424•5555. � ,I <br /> o I <br /> �A <br /> 7/ <br /> \/ � <br /> a <br /> ACKNOWLEDGFMENT Of CONDITIONS <br /> The unde�signed owner/apUlicant hereby agrees to hold and save harm- <br /> – less the City of Everett from any and all claims for damages, cosis, <br /> - expenses, or ca��ses of action ihat may arise because of installation <br /> c_ ��=�G �_ ���/�� and maintenance of the improvement or other right-M�way use hereto <br /> :c"� . a%'•r�. <br /> applied for and turiher a9rees to remove same upon notice from Ihe <br /> A�proved for C�onsiruction Date Cily and to replaco public property damaged thereby. <br /> � - ��l� <br /> FIN4L WS�ECTION Date <br /> Approved as Constructed Signature of ApFlicant Date <br /> everMt PUBLIC WORKS DEPARTMENT WORK AUTNORIZED BY TH19 PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 180 DAYS OF L�iTE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett WA 98201 BE DILIGEWTL" PURSUED TO COMPLEi ION. THIS PERMIT MAY 8E <br /> Phone: 259-8815 CANCELLED E`!THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PHOJECT OVER 90 DAYS DURATION. <br />