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>H� <br />r0 <br />G ;-3 CA <br />t>H" E 4 <br />�H7�d <br />rpFO V1 r�yH�I <br />L'1 O 0 <br />O ~H] <br />AH� <br />g `A <br />C] t7 y <br />y <br />H0CCA <br />C) <br />I t <br />L3 <br />Chi <br />,Us <br />Date <br />Appi-il" n rot <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing <br />Describe Proposed Work O ker. 65"09'e 6 <br />PuULc Works Permit <br />elda DePt. e. <br />Public W(rks Fee = - -- <br />101.1 Fee <br />Lev APPI Fee Pud $ <br />Belli Due <br />Project Address fit known) -e, PnL ��� S///tt� i5d <br />Attach four (4) copios of plans for proposed work • Draw to sralf and noteCeollowingerline e. <br />oas f applicable. <br />ppli abl <br />• Property Lines • Indicate North <br />• Outline and dimensions of all existing and • Show any proposed grading changes <br />proposed structures on the lot • Show measurements <br />• Existing and proposed utilities <br />PERMIT CONDIP,ONS <br />1. All calls 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 />3. Call Location Underground Service 48 his, before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />Approved for Crnetructlon Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />W <br />PUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett WA 98201 <br />Phone: 259-8810 <br />3/zGjgo <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Z <br />0 <br />H <br />U) <br />0 <br />a <br />The undersigned owner/applicant hereby agrees to hold and set a harm <br />less the City M Everett from any and all claims for dama,es, costs. <br />expenses, or Causes of action that may arise because of installation <br />and maintenance of the improvement or other righ4ol•way use hereto <br />applied for ar.d further agrees to remove same upon notice from the <br />City and to replace public properly damaged thereby. <br />Signature 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 />SE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAN BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />