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i <br /> Date� p p <br /> � Pu�l¢Works Perm <br /> ApplicUtion For eiep Deo�.�_ <br /> PUBLIC WORKS PERMIT PUDi¢WrnxaFee <br /> Tolal Fee s <br /> Lesa�oo�.�ee PuE s <br /> Print or Type Only ee�.��oo�� s <br /> _ I � r�t t�-S+-�� �ian l I- ���7 Cc�l l�, i A���' a �� � <br /> Owner MaiHng Adtlress Gry Zip Phone <br /> �l�l l�L`)►'1 f �31Y� Ill ��1�J/�� �7�1/d S�Afr1� � 7 n�Z.� <br /> ApplicaM ailing Address City Lp Phone <br /> Oeacribe Proposed Work _�� 1H^ �� T F�{C�v���'N� <br /> Prolect Address(if known) � , � -rj Q ,' . . �� � <br /> Attach four(4)copiea ol plens for proposed work- Draw to scale and note the following as upplicable: � <br /> • Property Lines � <br /> • Centerline oi sireet � <br /> � Outline and dimensions of all existinq and • Indicate North <br /> proposetl struCtures on the lot • Show any proposed grading changes <br /> • Existing and proposed utili�ies • Show measurements <br /> DO NOT WRITE BEIOW THIS LINE � <br /> PERMIT CONDIiIONS O <br /> 1.All calle for Inspection shall be made 24 hrs.in advance•phone 259•881 O. <br /> 2.All work ahell t�e pertormed in accordence with this permit and current City of Everett Design and Conatructlon ' <br /> StandeWs enA Specificatlons. <br /> 3.Call Location UndergrounA Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800-4Q4•5555. <br /> � <br /> I���� �'���«�.r� � <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 ol Everelt irom any and all claims lor damages. costs. <br /> expenses, or causes ol action ihat may arise because of installation <br /> and maintenance of the improvemenl or other iighFol-way use bereto <br /> Approved lor Construction applied lor and furiher agrees to remove same upon notice I�om the <br /> Date City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature ol Applicant Date <br /> everetl PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST �E STARTED WITHIN <br /> � 3200CedarSireel 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER ;S TO <br /> Everet�.WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br /> Phone:259�881U CANCELLED BY THE CIiY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OV�R g0 DAVS DURATION. <br />