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L�8tQ�1J� I Pu�Lc Works Permil• __ <br /> Application For Bl�p Deo�.• � — <br /> PUBLIC WORKS PERMIT Pu�licWorksFee — — <br /> .a�a�Faa s_ <br /> �eaa noo�Fse rs�a S <br /> Belence Due S_ <br /> Print or Type Only — <br /> ��F�� l'��m� w i��� ��,�W�-��__�I_u �T1YY)....� �2� i a��-��c,� <br /> Owner Maili A�dress City Zip Phone <br /> �n7 I � <br /> Applicant Mailing Address Cily Zip Phone <br /> Describe Proposed Work �.��� �'V� �/�L-� <br /> W <br /> Project Addross(if known) � <br /> Attach four(4)copies of plans for proposed work-Draw to scale and note the lollowing as applicable: � <br /> • Property Lines • Centerline of street � <br /> • Outline and dimensions of all existing antl • Indicate Norih <br /> proposed structures on the lot • Show any proposetl grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE O <br /> PERMIT CONDITIONS <br /> 1. Ail calls for inspection shall be made 24 hrs in ad�ance- phone 259•881 5. � <br /> 2. All work shell be performed in accordance with this permit and current City ol Everett Design and Construction <br /> Standerds end Specifications. <br /> 3. Call Location Underground Service 48 hrs.before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> Pl/B��c ai'o.ers f�-,em„— ,✓or .pF���,e.�v `r_'�' O <br /> ��� � <br /> � <br /> O <br /> a <br /> ACKNOWLEDGEMENT OF COND�TIONS <br /> The undersigned owner/applicant hereby agrees to hoid and save harm- <br /> less the City of Everett from any and all claims for damegeq costs, <br /> expenses, or causes ol action thal may arise because of installetlon <br /> and maiMenance of the improvement or other right-of-way use hereto <br /> Approved for Cons;ruction Date applied lor and further agrees to remove same upon notice Irom the <br /> City and to replace pu6lic property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Constructed Signature of Applicant Date <br /> everett PUBL�C WORKS DEPARTMENT WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br /> � 3200 Cedar Sireet 180 DAY� OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Everett,WR 98207 BE DILIGENT�Y PURSUED TO COMPLETION.THIS PERMIT MAY BE <br /> Phone:259-8815 CANCELLED BY THE CITY UPON ANY STOPPAGE Of WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />