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/ \ <br />Date�� <br />Applicalion For <br />P�'BLIC WORiCS PERMIT <br />Print or Type Only <br />Owner <br />Applicanl <br />Ma <br />Oescribe Proposed Work L—L —�1 - ��._t.�.� � <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />Pu�lm Works Pormll a _ <br />BIGp. DepC s _ <br />PWLc Wo�ks Fca <br />TOlal Feo 5 <br />Less Appl Foe Paitl S <br />Balance Duc $ <br />the follnwing as applicabie: <br />• Centerline of street <br />• Indicate North <br />• Show any proposed grading chang�s <br />• Show measurements <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be peAormed in accordance with this permit and cu«ent City of Eve.rett Design and Conslruction <br />Standards and Spedtications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER �•�00-424-5���,QY�/1/i�� <br />1 A% <br />/.ZL��GaCi <br />�� �e <br />//ii �,q�„� �.o �'v <br />�2�/�� �i 7 CL. LtJ2Z'�cc/'%'»�2v�zJ Q.e-d%�� '�� <br />�� �.� 2C�� � � a.w �� �� 2� ,�e �wz� <br />f�' �'y,� Q �i' <br />� � CcJ� � � o�.� v.� .�v C�<� �, � <br />�riu�-7` �c C'om����� ,�t_� c�z� G��� 7�e�f <br />�� � � &�D-f2� .S.SSS .� cz- w�� ��.��ti <br />� <br />O <br />��� `',��J���' � ACKNOWLEDGEMENT OP CONDIilONS <br />•����� �/ The undersigned owner/applicant hereby agrees tn hold and save harm- <br />— less the City of Everett Irom any and all claims for damac�es, costs, <br />expenses, or causes of action that may arise because ol installation <br />and maintenance of �he improvement or other right-o4way use hereto <br />applied fer and further agrees to remove 5ame upon notice Irom the <br />Approved for Construction Date City and to replace public properly damaged thereby. <br />FINAL INSPECTION Dale <br />A.pproved as Constructed <br />everet[ PUBLIG WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everelt, WA 98201 <br />Phone: 259�8t370 <br />Signature of Applicant Date <br />WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS Of DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />8E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 6E <br />CANCELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DHYS DURATION. <br />