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Date_�D I P„�,�<<vo..sr�7•��ry�.-.�� ,n <br /> ApP�ication For H1°� 0`•0' • `—�—� �I��✓I_ <br /> PUBLIC WORiKS PERMIT P�°���W�,�=F�� -------- <br /> To,a���� s_ _ <br /> less Anal.Fn,e Pam rJ <br /> Balancc�uc $ <br /> Print or Type Only — <br /> ��e.������0 �����0 1� �'�lua � ��a� q��l <br /> Owner M ding Address Cit 2ip Phone <br /> Applicant Mailinq Address City Lp Phone <br /> Describe Proposed Work <br /> 1 <br /> W <br /> Projec�Address(if knownl � <br /> Attach four(4)copies ol plans for proposed work� Draw to scal tl note ihe tollowing as apPlicable: � <br /> • Property Lines • Centerline ol sireet � <br /> • Outline and dimensions of all existing and • Indicate Nor�h <br /> proposetl slruclures on Ihe lot • Show any proposed grading changes <br /> • Exis�mg and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT COND�TIONS O <br /> 1.All calls for inspection shall�e made 24 hrs.in advance-phone 259•8810. � <br /> 2.All work shall be performed in accordance with this permit and wrrent City of Everetl Design and Construction <br /> Standards and Specifications. <br /> 3.Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> n <br /> . ��/�.��t/ �20� �'�, O <br /> � ,i—y—<�3' � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less Ihe City of Everett Irom any and all claims for damages, cosls. <br /> expenses. or causes of action that may arise because ol installation <br /> and maintenance ol Ihe improvemen� or o�her ri9hPo1-way use hereto <br /> applied lor and lurther agrees to remove same upon notice Irom the <br /> Approved lor ConslrudiOn Date City and ro replace publlc property tlamaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Cons�ructed Siynature ol Appllcant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200CedarStreet 1B0 DAYS OF DATF PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett.WA98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON 7HIS <br /> PROJECT OVEF7 90 DAYS DURATION. <br />