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� - <br />-- --- --- -- - --- ------------ <br />r �:>�.,���nr�+a�u�*.�si;�+;, ., <br />� <br />I.F.f[�t:n�ir� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />PuoLc V/wAa Parmit . <br />s�ae. oeoi.. 9C1/25�c3 <br />Pubbc Works iee <br />Tolai Fee S <br />iEs9 POPI. Fee Ptid $ <br />Baianca0ue S <br />Cateway Group Homa 6016 S. Broadway Everett 98003 353-8497 <br />Owner Mailing Address City Zip Phone <br />IIayview Oonet. i70B E 5500 S iaqqloy WA 98260 221-7174 <br />Applicant Mailing Address City <br />Describe Proposed Wurk Offir.e sdAf tien hn qmy� he,�w <br />Project Address (il known) <br />Attach lour (4) copies of plans lor proposed work - Draw to scale and note the lollowing as applicable: <br />• Property Lines • Centerline ol street <br />� Outline and dimencions ol all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />� Exisling and proposed utilities • Show measurements <br />Phone <br />PERMIT CON�ITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be perfermed in accordance with this permit ar�d current City ol Everett Design and Construction <br />S�andards and Specifica�ions. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FqEE NUMBER 1•800•424•5555. <br />���1/:�: ��%�'CG�-:.i�(''.,'.�v � ,.^% ;,1-!'c•:-cc� <br />Approvetl lor Construction Date <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200CedarSireet <br />EvcretL WA 98201 <br />`_ Phone:259�8810 <br />�/' . � r <br />,,.� �� - , � <br />�i'—/S -90 <br />ACKNOWLEDGEMC-NT OF GONDITIONS <br />The undersic�ned owneVapplicanl hereby agrees to hold and save harm- <br />less ihe Cdy ol Everelt irom any anil all claims for damages. costs. <br />expenses, or causes ot action thal may arise because of installation <br />and ma�ntenance of the improvemenl or other riyht�ohway use hereto <br />applied for and turiher agrees to remove same upon notice Irom the <br />City and to replace public properry damaged lhereby. <br />Signature ol Applicant Date <br />WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WI7HIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER �S 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 />