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i <br />� , ,r� <br />� Date % . <br />AppliCalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing Address <br />, <br />Applicant <br />Describe Proposed Work <br />Public Worx� permlt • , <br />BICp Deol � <br />PubLc WorXa Pee s <br />TatelFee <br />Lees ROG�� Fee Paia f <br />Bebnce Oue i <br />�UC?�-/� 1 5c�3 - _n� <br />City Zip Phone <br />//�f �/�; � r ; f/� <br />City Zip <br />IL Dlr�i�. 1U <br />/ �U�Ldin, Tr�� <br />Pre�act Adtlress (if known) yes��� � �/Fi /1101�� / _ (%N,�C' / I _ <br />Attach four (4) copies of plans lor proposed work - Draw to scale and nole the lollowing as applicable: <br />• Property Lines • Centerline of street <br />• Outlinr, and dimensions of all existing and • Indicate NoAh <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />/_ <br />l�_51�-�y �_, <br />Phone <br />PERMIT CONDITIONS <br />t. All calls for inapection shall be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be peAormed In accordance with ihis permit and curtent City ot Everett Design and Construction <br />Standarda and Specificationa. <br />3. Cell Locetion Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1•600-424•5555. <br />r <br />��l,� �•�rc;� _, �i i"�ti„•,�:�� <br />, <br />��,C LvIL�IJ�. `�:_ n.r�ll � r <br />p–n ��• , � � - �_c. .I �i �//� i r <br />Approved for Cons�ruction � � � �Dafe <br />FINAL INSPECTION Date <br />Approved as Const�ucted <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8B70 <br />__ L c, c.; c r`_, <br />4 c<�,c, <br />ACKNOWLEOGEMENT OF CONDITIONS <br />The undersigned owner/applican� hereby agrees to hold and save harm- <br />less the City of Everetl from any and all claims for damages, cosis, <br />expenses, or causes ol action that may arise because of installation <br />and maintenance of �he improvement or othe� �ighFol•way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property demaged Ihereby. <br />� <br />� !�<G%�.y� �i�/��//�� <br />Signatur— e o�nt' � • Dafe <br />WORK AUTHORI2ED B9 THIS PEqM1T MUST BE STARTED WITHIN <br />180 �AYS OF DATE PERMIT IS�SUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIc <br />PROJECT OVER 90 DAYS DURATION, <br />