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Date��9d <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Sl / — l % rh <br />Mailing Address <br />� <br />/ � / r <br />Describe Proposed Work �p/ �u 1 M �N� '.f /?,IDc P�A /� /�� <br />Project Address (if known� <br />Attach lour (4) copies of plans lor pioposed work • Draw to sw�e and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the Iot <br />• Existing and proposed utilities <br />PuElic Worke Parmil • `� � /� � <br />eiey. oeo�.. 6 <br />Pubbc Wo�ks �ee <br />Tutei Fee s <br />Le6! AppL Fee PeiJ S� <br />aa�e��ao�a s 770— — <br />• Centerline of street <br />• Indicate Norlh <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />i. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be performed i� accordance with this permit and current City of Everett Design and Construction <br />Standerds and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-600-424•5555. <br />'T, �cui� Lc�O�i� .�0 6�0- o%>u �vv �,.� 4� <br />� .�f'w f��,��L�� o��t'� � �-as yo . �a� �i""�ciG-a�J <br />.S (oo � � �ocJ- ,� 8e -PQa� <br />c�, �'� ��,�� ,G�.�vs�� <br />Ur ' cra,« -a�-90 <br />Approved lor Cons�ru n !� Date <br />�/ /� <br />LG'•�' / i � J ':/Lf <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Ceder Streel <br />Evcrett,lVA 98201 <br />Phone:259�0810 <br />�ar.� .,� <br />� 4�.n�. N, �i���r, <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />The undersigned owner/applicant hereby agrees te hold and save harm- <br />less the Cily ol Everett Irom any and all claims for damages, costs, <br />expenses, or causes of action that may arise because ol installation <br />and mainlenance of the improvement or other righ4of�way use herelo <br />applied for and further agrees to remove same upon notice irom the <br />Cit �o replace publi roperty damaged thereby. <br />S- 3v— 40 <br />S ature ol Ap � nt Date <br />WORK AUTHORIZED THI PERMIT MUST BE STAFTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUfiSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY TP:E CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />