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Dste�i�i� <br />� � i <br />ApPlicaLon For <br />PUBLIC WORKS F'ERMIT <br />Print or Type Only <br />u t G� <br />• <br />� <br />F�:,._::: �:�� ,. ^�- _ <br />Bmp Depi � �� <br />Pueic worhs Fee <br />Totel Fee 5 <br />Lr55Ro0��eePe��S _ <br />pa'.anr� Du, <br />L W!-� p�. �l atl- � o �/ l l l 35 �' f] v r SE _ Snr,�,arnu�� 9d'z- 9ri 3 3�/- 75'G, 7 <br />Applicant Mailing Address Cdy Zio Phone <br />Descnbe Proposed Work <br />Projr,d Adtlress (II known) <br />Attach four (4) copies of plans for proposetl work � Draw to scale 3nd note ihe lollowing as appGcablc. <br />• Property Lines • Centedine of street <br />• Outline and tlimensions ol all ealsting anA • Indicate North <br />oroposed structures on the lot • Show any propo5ed �patling changes <br />• Ezisting and proposed util,ties • Shov� measurements <br />PERMITCONDITtONS ' <br />1. All calls for inspe�tion shall be made 24 hra ��r, advance - phone 259•6810. <br />2. All work shall be pertormed in accordance with ihis permit and current Cily of Everetl D�sigr. and Constru�tinn <br />Standards and Specilications. <br />3. Call Location Underground Service �18 hrs. befcr= you dig. TOIL FREE NUIJIBER 1-SOO•�i24•55J5. <br />(i �f" /. � _ <br />�li � /\ /�1:, <br />ApProved lor Construction � <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />f� <br />_i7 � `y�_�• <br />� <br />i —� �/� <br />ACKNOWL[DGEMENT OF CONOITIONS <br />W <br />H <br />� <br />� <br />� <br />� <br />� <br />0 <br />� <br />� <br />O <br />a <br />The untleisigned owner/applicant hereby agrees N hold and save harm- <br />less the Gty of Everett Irom any and all claims lor aamagrs. cosis. <br />expenses. or causes of aclion that may arise bewuse of installation <br />and mainlenance ol ihe improvement o� other righbol-way use herr.to <br />applied for and furthcr agrecs Io remove 5ame upon notir,e Irom Ihe <br />Dale City and to replacc pubim property damaged thereby. <br />Dale <br />5�9nature ol Applicant Datc <br />l\ �RK AUTIiORIZED BY TI115 PERMIT MUST BE STARTED WITHIN <br />1B0 DAVS OF DATE PERMIT IS ISSUED AND 7HEREAFTER IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PEFMIT MF.Y BE <br />CANCELLED �V THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PI�OJ[CT OV[R 90 DAYS DURATION. <br />