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Date..���p <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />��,Nh ��ZZ <br />!f —�CS ��ON 5'� • � <br />ApplicaM <br />�979 /i'� <br />Mailing Address <br />PuEI¢ Works Permif • <br />eiaa oam.. �6 �J�q % 3— <br />Pueuc woaa Fee S <br />Tolsl Fee <br />Leas ApO� F�! �eiE s <br />BebneaDue S <br />'✓rre/� ��OS� 353-38'9/ <br />Ciry Zip Phone <br />�Vcr�fj� 9�zOf� .�s�T—/S�9/ <br />City Zip Phone <br />Describe Proposed Work Z/ A D a I i 1 C� �v 5 �/,� aTM � X T(S NQ S/ay 3 Q 1� <br />�K/S� �u� r3F', n Rc�v� _ <br />Project Address (if known) 6� L 2 �rOq�+ w.t <br />Attach four (4) copies ol plans lor proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of sireet <br />! Outline and dimensions o1 ail existing and • Indicate Norih <br />proposed ntructures on the lot • Show any proposed grading changes <br />• Enisting and proposed utilities • Show measurements <br />PERMIT CONDITIO'.S <br />7. All calls tor inspection shall be m,de 24 hrs. in edvance - phone 259•881 5. <br />2. All work shall be performed in accnrdance with this permit and currer�i Cily o� Everett Design and Consiruction <br />Standards and Specifica�ions. <br />3. Call Localion Unde�ground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•S00•424•5555. <br />� f�%i_�GiG l��O�.S �F�,��T ,Z�EqUi�E�/ <br />Approved 1or Construction Date <br />FINAL INSPECTION <br />Approved as Cons�ructed <br />everett PUBLIC WORKS DEPANTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259-8815 <br />�-���/ �% ��o <br />PCKNOWLEDGEMENT OF CGNDITIONS <br />W <br />� <br />� <br />� <br />� <br />U <br />� <br />� <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less lhe Ciry ol Everett Irom any and all claims tor damages, cosis. <br />expenses, or causes ot action that may arise because ol installation <br />and maintenance ol ihe improvement or other right-of�way use hereto <br />applied for and further agrees to remove same upon notice Irom ihe <br />Ciry and to replTce public property damaged thereby. <br />Signa�u Applicant Date <br />WORK A..iHORIZED BY THIS PEPMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFT�R IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEnM1T MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO�ECT CV[R 90 DAYS DURATION. <br />z <br />0 <br />� <br />.. <br />C9 <br />m <br />=a i <br />�� <br />in x <br />0 <br />m <br />mo <br />n <br />o; <br />m <br />_ —�i <br />m <br />.o z <br />a --� <br />rx <br />--1 V+ <br />� <br />� <br />O n <br />3 <br />=m <br />mN <br />om <br />C N <br />3 Vr <br />m <br />Z� <br />-i r <br />m <br />a <br />� <br />� <br />x <br />z <br />1 <br />_ <br />w <br />z <br />a <br />� <br />� <br />m <br />