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�IN <br />it <br />t-, <br />mzx <br />Q H <br />a <br />H xyy <br />H ZH <br />H:z <br />o xo <br />'it H IV <br />W H <br />H7 V <br />H l7 <br />Q H <br />zy <br />x <br />HH <br />g14 <br />H <br />cU C'l <br />�C to <br />HrA <br />O C/i <br />a <br />Date�%- <br />Application For <br />PUBLIC WORKS PERMIT <br />O c] i. <br />Print or Type Only f; <br />a �T, TO POSTING 5 -z6 93 <br />�.atr <br />Protect Address (if known) <br />• <br />Public Works Permll • 9z Q t 1 <br />Bldg Dept <br />Public Worm Fee <br />Tolal Foe <br />Loa. AppL Fee Paid $ <br />Balance Due $ <br />Attach four (4) copies of plans for proposed work- Draw to scale and note the following as applicable. <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />''� �I.. PERMIT CONDITIONS <br />� .I..S 1. All cads for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />felt asp' 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•$00.424.5555. <br />+kw seek. <br />!�i <br />17a�i /-Z-7-9Z <br />_. <br />- Eat-&Joull y_9z <br />ApprovgDi4q Construction D �to7 <br />x3 `J <br />AL INSPEC 10 Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />am . Everett, WA 98201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />z <br />0 <br />Ch <br />0 <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs. <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace p bllSpf party damaged thereby. <br />z1-7 <br />Ignature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED 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 THIS <br />PROJECT OVER 90 DAYS DURATION. <br />