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Date�6 <br /> Pu�lic Works Pnrmit r /� � �7 <br /> Application For emA ooa�.._ ��O �1a.�d.7 <br /> PUBLIC WORKS PERMIT PublicWo�k3Fe0 <br /> ` Total Fee $_ <br /> , Less AOP�Fee Paltl � <br /> Print or Type Only ea„��a o�e 5 <br /> � / � �/ S � 7 <br /> � VARS J p D / - /7I�S/(q��/ � SC27TIC 9�8/0 b � (S O CJ <br /> Owner Mai{ing Adtlress � City Zip Phone <br /> �-�/.�/�9C- ` � � � r ' � I <br /> Applicant Mailing Address City Zip Phone <br /> � <br /> Describe Proposed Work ' "��� �~— ����? �`��M t.✓ � <br /> Project Address(if known) ��� `'9 ' y� t � � <br /> Atlach f�ur(4)copies of plans for proposed work- Draw lo scale and note the folloµ!:�g as appLcable: � <br /> • Property Lines • Cenlerline of street � <br /> • Outline and dimensions of all existing and • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measuremenis � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIJNS � <br /> 1. All calls for inspection shall be made 24 hrs. in advar.ce- phone 259•881 5. � <br /> 2. All work shall be performed in accordance with �his permit and current City of Everett Design and Construction <br /> Slandards and Sper.ifications. <br /> 3. Call Location Underground Service 48 hrs. before you dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> �iL.E�E.9�j/ 1����E f�Li� P�c:c�r�JiT— � <br /> /-�c�'.riidi�✓lr /U«G�C' T �'iSiECyC �9.u,O.�•y!i'iir/l� <br /> � C'C�Oc /aiQ.('.fi:UCS' ��'C!%i.�'c=/7�Es7lii.'. . � <br /> r <br /> ,`�� � � <br /> s//�` � <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigmad owner/applicant hereby agrer.s to hold and save harm- <br /> less ihe City �f Everett (rom any and all claims for damages, cosls, <br /> expenses, or causes of action Ihat may arise because ol installation <br /> and mainlenance of the improvement or other right-ol-way use hereto <br /> AppmveC for Construction Date applied tor and turiher agrees to remove same upon notice from the <br /> City and to replace public property damaged thereby. <br /> FINAL INSPECTION Date <br /> Approved as Conr,tructed Signalure of Applicant Date <br /> everett PUE,IC WORKS DEPAFTMENT WORK AUTHORIZED BY THfS PERMIT MUST 8E STARTED WITHIN <br /> � 3200 Gedar Street 180 DAYS OF DATE PERMIT IS ISSUED .�ND THEREAFTER IS TO <br /> Everett.WA 9P.201 BE DILIGENTLY PURSI;ED TO COMPLETION. THIS PERMIT MAY BE <br /> Phane� 259�8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />�o <br />