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H <br />.. �o <br />Applicalion For � <br />� PUBLIC WORKS RERMIT <br />PUBLIC WORKS DEPARTIU�NT <br />3200 Cedar Street = <br />Everell, WA 98201 (425) 25�+8810 <br />TYPE OR PRINT ONLY <br />Owner <br />Descri6e Proposed Work <br />PROJECTADDRESS (if known) <br />5-b'a"� � o g � � � <br />� �mo-a-a —�i <br />. .-1 P+�-I i J tM4 O <br />2 S <br />Date 2� 9 <br />Public Works Permit ti / ///D� <br />� <br />Buildiny Permit k _ <br />Public Works Fee $ ���� OO <br />�r��lt- 9�s�-o3 �1Z�� - 353 - <br />Cily Zip Phone <br />Gd.,�obds 9�ozr� ��zs ��X ; <br />City Zip Phone <br />Attach four (4) copies plans for proposed work - Draw lo scale and note Ihe tollowing if applicable: <br />• Proporty Lines • Oulline and dimensions ol all existing and proposed structures on the fot • Ezisting and proposed utilities <br />_• Centedine ot street • Indicate North • Show any proposed grading chanqes • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8870 <br />2. Ail work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. . <br />3. Call Location Underground Service 48 hrs. before you dig, TOLL FREE NUMBER 1-B00-424-5555 <br />'{o �e <br />STYQe'fS CC¢4n �i � 4�C l/��e-T <br />Uane P2r � (oe� <br />� �/ <br />��LL� I' �iu � <br />. . :� . �. <br />FINAL INSPECTION <br />Approved e:; Constmcled <br />Date <br />��oraveo� an .�'S 99 <br />W <br />� <br />V / <br />� <br />0 <br />� <br />V / <br />O <br />a <br />�` `!','7 <br />ACKNOWLEDGEMEYT OF CONDITIONS <br />The undersigned owner7applicant hereby agrees to hold and save harmless <br />the City ol Everett.lrom any and all claims tor damages, cosls, experses, or <br />causes of action that may arise because ol installalion and maintenance ol the <br />improvement or olher righ4ol-way use hereto applied for and turther agrees to <br />remove same upon notice Irom the City and to replace pu6lic pmperty dam- <br />aged the[eby. ,��/ G�� <br />% L , <br />SigTiiatyr�e.o Ap icTan� ate <br />VJORKAUTHOR�D BY THIS PERMfT MUST BE STARTED WIhiIN 180 DAYS OF DATE PERMIT IS ISSUEDAND7HEREAFTER ISTO BE DIIJGENTLY PURSUED TO <br />ODMPLEf10N. THIS PERMff MAY BE CANCELLED BY THE CITY UPON ANY STOPFAGE OF WORK ON THIS PRQIECT OVER 90 DAYS W RAT10N. <br />