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��� <br />��x <br />q H <br />�H[n <br />ryC � C�] <br />H� <br />oxo <br />'i1 H M <br />� <br />H <br />�HG� <br />OH <br />�/��g <br />y� V C] <br />�H� <br />HH <br />g`� <br />H <br />c�Gv� <br />��� <br />zHV� <br />HOm <br />/ <br />� �� ai ,. <br />�._� <br />/ <br />Date � G � <br />� <br />AppliCalion Fof <br />PUSLIC WO�KS FERMIT <br />Print or Type Oniy <br />� <br />n�.,.,e. <br />Address <br />7.ip <br />Publ¢ Ylo�hs P �il e _ <br />oieo. oao�.• — <br />PubllcWorksFm 5 <br />Tolal Fco <br />Less Ao�� Poo PoiE S <br />eamncu ouo S — — <br />Oescribe f'roposed Work <br />Project Addreas (if known) �.r � `"� <br />Attach lour (4) copies of plans for prop sed work - Draw to scale and note the tollowing as applicable: <br />o Property Lines <br />• Outline and dimensions of all existing and <br />proposed siructures onihe lot <br />• Exisling and proposed utililies <br />9�Id� <br />Phone <br />• Centedine ol sireet <br />• Indicate North <br />• Show an/ proposed 9rading changes <br />• Show measurements <br />I i� PERMITCONDITIONS <br />� � 1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />i <br />� 2. All work s�all be pedormed in accordancc with this permit and current City of Everett Design and Construction <br />� Slandards and SpeCiliCa�ion5. <br />, 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�%(�� �C2sr�i7` /sSl/�'.v r9c,l2E'�.��/ <br />/ <br />I � ' <br />� / � <br />, <br />. . .. � . <br />/ , /� <br />i" <br />"'�`'� �U' <br />c <br />,�. . ; �/���\1�� <br />1�'`������ � <br />�i�) � <br />1 <br />Approved lor Conslruction - �� �.1'•/ Date <br />� <br />RNAL INSPFCTIOF! <br />Approved as :ons�ruC�ed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phona 259�8815 <br />.f <br />�,.�'/� 86 <br />� <br />ACKNOWLEOGEMENT OF CONOITIONS <br />The undersigned owner/applicant here6y agrees to hold and save harm- <br />less the City of Everett trom any and all claims lor damages, costs, <br />expenses, or causes ol action that may arise because ol installation <br />and maintenance ol the imorovement or other ri9h4ol�way use hereto <br />applied for and furiher a�rees �o remove same upon notice ircm ihe <br />City and to replace public property damaged Ihere�� y. <br />Si9nature ol Applicant Date <br />WOFiK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br />BE DILIGENTLY PURSI'ED TO COMPIETION. THIS PERMIT MAY 8[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJ[CT OVER 90 DAYS DURATION, <br />