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pate�� �� 3 <br />P.pplicaUon For <br />PUBLIC WORKS P�RMIT <br />Print or Type Only <br />�� <br />� <br />Mailing Address <br />Address <br />up <br />PuOiic WorW iermit •�( I Z� <br />B�Op Deol.+ �3j��0 �,3 <br />Puolicwork�fae ^ �� <br />To1�IFee s R� <br />Lesa RppL Fee Pe1G 5 <br />O� <br />OelenuUue s a� <br />Describe Proposed Work ` Ors�� ,V�vJ `��t c�Y'l l�'� _. <br />Pro�ect Address (il known) <br />Attach lour (4) copies ol plans for proposed work • Draw to scale aiid nole tne lollowing as applicable: <br />• Property L�nes • Centedine of sireet <br />• Outline and dimensions of all e+cisting and • Indicate North <br />proposed slructures on the lot • Show any proposed greding changas <br />• Existing and proposed util�ties • Show measurements <br />PERMITCONDITIONS <br />t. All calls for inspection shell be rr.ade 24 hrs. in advance • phone 259•8815. <br />2. All work shall be pedormed in accordanco with this permit and current Ciry ol Everett Design and Construction <br />Standards and Specifications. <br />3. Cell Locetion Underground Servic=48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�% � e �o,,,.� .,... �,,. � •k� � 1,.c.�. o < h e �.. o ., � � <br />l O� �-- �-�n.�- �er v�� e��—, `T�e a O� 5 e.�i-� a.c� <br />�� .�.. �r.ve ws..} <br />c, o�,f ccS¢. i� -iv o <br />� I r�/� <br />l� VC.'^'j � d�ty-i tv�� <br />ew� ed�� <br />Plo�- �lah. <br />F�NAL INSPEGTIOP' � \ ` <br />Approved es Conslr�cted `) <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everetl, N'A 98207 <br />Phone: 259-BB15 <br />g �-ds ` <br />�a�t;.�,�s � S�J- ,:,.lo d�c <br />-}-� .:�l�,l� R k � w� l 1 wvn� �� <br />�-- � b �� m ,,.Jl- o � <br />.�t.S S�O W N O �'t �'^� <br />W <br />H <br />� <br />� <br />� <br />O <br />ACKNOWIEDGEMENT OF CONOITIONS <br />The undersigned owner/applicanl hereby agrees to hold and save harm- <br />less ihe CAy ot Everetl Irom any and all claims lor damagea cosls, <br />expenses, or causes of aclion Ihal may arise bacause oi installation <br />and maintenance of the improvement or olher righ4ohway use hereto <br />epplied lor a.�d turther agrees to remove same upon notice irom the <br />City and to replace public property damaged thereby. <br />Signature of Applicant � - � vam <br />WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br />700 DAYS OF DATE PERMIT IS ISSUED AND THEREAf"TER IS TO <br />BE DILIGENTLY PURSUED i0 COMPLETION. THIS PERMIT MAY BE <br />CANCELL[D 6Y THE CITY UPON ANV STOPPAGE OF WORK ON iN15 <br />PRnJECT OVER 90 OAYS DURATION. <br />'_1 <br />.� <br />1 <br />� <br />� <br />