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Date�� PUEGc Warks Po�m11• <br /> � ��,.-/7� <br /> Applir.ation For a�aa-ooai.+— <br /> PUBLIC WORKS PERMIT Pu�Tf�AFoeFeO : — <br /> , Losa Aun�Fee Pe�E s _ <br /> Print or Type Only ea�a��an�e s <br /> 6 99 /�ssrr�i?,�U 5.��/�n. C 3 % K.F,uI�'—,��C�Qd-.�o5� 7�3-7Gal <br /> Owner Mai mg Addre��^ Cit �� <br /> Y ��P P�ne— <br /> �n� - <br /> Applicant Mailinc�Address City Zip Phone <br /> Doscribe Proposed Work /ONA� r�1'I��y�i��((,� � l��('il ��(j�� �S Pf/fG �f'�� <br /> Project Address(if known) ��/.� � ��NM/YCLN �d/�l,l � <br /> / � <br /> Attach four(4)copies ol plans for proposed work- Draw to scale and note the following as applicable: � <br /> � Property Lines • Centerline of sGeet � <br /> • Outline and dimensions of all existing and • Indicate North <br /> pruposed structures on the lot • Show any proposed grading changes <br /> • Existinp and proposed utilities • Show measwements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERfdiT CONDITIONS O <br /> t. �II calls for inspection shall be made 24 hrs. in advance• phone 259•881 5. � <br /> 2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Constructiun <br /> Standaids and Specifiral�ons. <br /> � 3. :all Loca;ion Underground Service 48 lirs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �� ���/Yl/% /UCrI ���jl Ui/lE=.Q ��� O <br /> ��� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the City ot Everett from any and all claims br dama�es, costs, <br /> expenses, or causes ol action that may aris� because of installation <br /> and maintenance ol the impiovement or other rioht-ot-way use hereto <br /> ApProved for Construction Date applied for and further agrees lo remove same upon notice from thr. <br /> City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approvad as Constructed Signature ot Applicant Date <br /> everett PUBLIC WORKS DEPARTtdENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar 5treet 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER iS 70 <br /> Everett,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION.THIS PERMIT MAY BE <br />�� Phone: 259-8815 CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br /> FROJECT OVER 90 DAYS UURATION. <br />