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oe►e ' i 9U <br />Applicatlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />1I <br />Meiling Add�ess <br />Clry <br />Pu01¢Wort�Permil• 9o��JS/ <br />Biau oeoi� • <br />PublK Worw� iee <br />Tot�l Fee a <br />Leu �DVI Fee P�iA S <br />B�i�nce Due 8 �� <br />�a m„ LOo �.Y- <br />- 5�� - �D- /6'-v3/ <br />3S3-�S:3 / <br />� <br />� : � . . / I � ✓ � • I / . i <br />�i ► I : ♦ � i L i'—�—� � -- � _--� <br />Pro�ect Addreea pl known) <br />Attach lour (4) coples ol plens lor pio�osed wo�k • Draw to acale and nole tha lollowing as applicable: <br />• Property Lines <br />• Outline and dimenslona ol all existinp nnd <br />proposed Blructuree on the lol <br />• Exlatinp antl proposad utlllties <br />• Cenlerlina of slreel <br />• Indicate North <br />• Show eny proposed grading chenges <br />• Show meaeurementa <br />PERMIT CONDITIONS <br />1. All cells tor Inepection shell be mede 24 hre. In advence • phone 259•8810. <br />2. All work ahell be performed in eccordence with thla permit and cuirent City ol Everetl Daelgn and Construcllon <br />Standarda and Speclllcationa. <br />3. Call Locatlon Underqround Servlce 48 h�s. before you dlg. TOLL FREE NUMBER 7-800-424•5555. <br />� .J.iI���Xe_�'-1t4.-/ �9Ltvf�jC C'.L�Ps.v �-[���/ �'7n� �a�.{�� <br />COri-Oh-� �t/ �Cc'G� -�+i .,L./t 'YLQ i,4 � �t. i.. . �yft �..- � �/, aS j . <br />�t/n 2an/�.�f �cc�'� �z�'r°azcxc/:. � <br />✓ J-GifC-�� �%'i1l.[yf /i�-e �'> CU'lI,J'L' /t,� 11!( ��LC?)t(':s� <br />� . �,o �,y. ��� c� � ��� >»��.��� <br />7, .11-,u�. _Tcn,`o���u� ��o�o�-�/s�d;�w..-/f�>v <br />� Jo,�.e ao ��c�-o/ 6� ,�� pa�� << �z/:. <br />� <br />(��Z��c� � <br />.�,w�c��2-' � <br />v�/ �"l�C %I'e� ��' �� "`��/ / �� � ACKNOWLEDGEMENTOFCONDITIONS <br />�> .1L � :�/crb� G� /,j O <br />Approvetl loJ�Conat�uction r ate <br />/ �,,,�/ ��-� -- � �,�� <br />/ /dL4�Q/ <br />FINAL N CTIO r Data <br />App�oved ae Conet�ucted / <br />everett PUBLIC WORKS DEPARTMENT �� <br />� 3200 Ceder Street <br />Everett, WA 88201 <br />Phone:259�8810 <br />W <br />H <br />� <br />The undersiBnad owner/epplicant hereby aqrees lo hold end save he�m- <br />�ess the City ol Everett Irom eny and all cleims lar dameges, costs, <br />e�penaes, or causes ol ec�ion Ihat mey erise because of Inatellalion <br />and mainlenance of the improvemenf or other rlghPof•way uae he�eto <br />applied lor and lurther agreea to remove same upon notice from Ihe <br />C�ly nnd to replace public property demeged Ihereby. <br />'Signalure ol Applid6nt �ale <br />WORK AUTHORI2ED BY TNiS ERMIT MUST 8E 5 ARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV B[ <br />CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />