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f ,-. <br /> Det2�L�..� c��oi��wo...ra� <br /> ApplicatiOn For emq.oeo�.• <br /> PUBLIC WORKS PERMIT PuEhcWorMnFee — -- <br /> Tot�l Fee s <br /> leas�ooi.Fee Pe�E S <br /> Print or Type Only Beiance0ue f <br /> r� ���n�d� �b �X �3 a aRao� �a-k� <br /> Owner Mailmg Address City tip Phooe <br /> � � <br /> Applicant Mailing Atldress City Zip Fnone <br /> Deac�ibeProposedWork � �C -� � J��rNIICJIJ�C,� JI/ /r l� ) <br /> W <br /> Project Addreas(if known) � <br /> Attech four�4)copies o�plan5 lot proposed work• Draw to scale and note Ihe followinp as applicable; � <br /> • Property Lines • Centerline ol street � <br /> • Outline and dimensions of all existing antl • Indicate North <br /> propoae�slructures on the lot • Show any proposed grading changes <br /> • E�isting and proposed utilities � Show measuremenls � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONOITIONS O <br /> 1.Ali�,all6 fOr Inapectlon 6Aall ba mede 24 hrs.in edvenCe-phOne 259-8810. � <br /> 2.All work shall be peAormad In axordance with this permit and current City ot Everett Deafgn end Conetruction <br /> StenAaMa end Spedficetione. <br /> 3.Call Lacation Underpround Service 48 hra before you dig.TOIL FREE NUMBER 1•800�4245555. � <br /> O <br /> N� ��J t��' ; T �z, ~ <br /> � <br /> O <br /> ��,-�,-�.<_� a <br /> ; (� . i �. •;;c�( <br /> . ACKNOWlEOGEMENT OF CONOITIONS <br /> � The undersigned owner/applicant hereby agrees to hold and save harm� <br /> less the City of Everett irom any and all claims for Oamages. costs. <br /> expenses, or causes of action that may arise because of instaitatior, <br /> and maintenence ol the improvement oi other right-of-way use hareto <br /> ap�lied for and lurther agrees to remove same upon notice Irom ihe <br /> Approved for Construction Date City and to replace pubiic property damaged thereby. <br /> FINAL IN5PECTION Dat� <br /> ApOroveC as Constructed Signature ol Applicant Date <br /> everett PUBLICWORKSDEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST BE STAHTED WITHIN <br /> � 3200CedarStreat 180 DAYS OF OATE 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 CIN UPON ANV STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />