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•--vate � - �� �� % <br />r' � <br />Application For <br />�UBLIC WORKS PEFiM�I' <br />Print or Type Only <br />Applicant <br />Describe Proposed Work <br />Project Address (�f known) <br />Mailing Address <br />Mailing Address <br />PuOlic Works Pcrmlt + ���— ��� <br />BIEg. Dept. s <br />Pu01it Woeks FCo y, <br />Totnl Fau <br />Loss AppL Foe Puitl S <br />Balonco Ouo S ��— <br />D2_ -��c�/1.�2��,v � ��� <br />Ciry Zip <br />_ ��,ec.�,��u c�.�y E:�� <br />Ciry Zip <br />� Gr.,.n r !'n..., ir'L�rnl� <br />Attach four (4) copies ol plans for proposed work • Draw to scale and note the �ollowing as applicabl=: <br />• Property Lines • Centeiline of street <br />• O��tline and dimensions ot all exi�ting and • Indicate North <br />proposed structures on the lot • Shovi any proposed grading changes <br />• Existing and propos��d utilities • Show measurements <br />l/ C�rr t��� <br />PERMIT CONDITIONS <br />1. All calls for inspeclion shall be made 24 hrs. in advance - phone 259-881 5. <br />2, Ali work shall be performed in accordance with Ihis permit and current Cily of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•000-424-5555. <br />/_ �O/'.K O� 02ic�cc.zv�/ To b�= t�o.dl's f�i.e Ci/'f/ Si H�/OFliZQ �3D7' <br />�- S/!i�/�'.19C/G ro t�� .P��noa.�.o �a N�a,e�.n �;�.��.on� Jc�%rr <br />O�e S9�J Cc�T. <br />.�. L�JOi.'-•e TU 9� �Do�c.�r-' fc2 f�ii,9CH.�/] �S'i�ErC'/i! <br />� ����'�(�� ��3��P <br />FI S CTION Date <br />Approved as Construcfed <br />everett PUBLIC WORKS DEPPRTMENT <br />� 3200 CedarStreet <br />Everett, WA 98201 <br />Phone: 259�8815 <br />:. <br />�J <br />♦�A <br />V♦ <br />O <br />a <br />ACKNOWLEDGEM[fJT OF CONDITIOtJS <br />Tne undersigned owner/ap�licant hereby agrees to hold and save harm- <br />less the Ciry ot Everett irom any and all clzims for damages, costs, <br />expenses, or causes of action that may arise because ol installation <br />and maint n nce of the improvement or other righhohway use herelo <br />applied for nd further agrees to remove came upon notice (rom thc <br />City and to eplace pub�operry dama�ed thereby. <br />WO K. AUTHORIZ BY THIS PERMIT MUST BE STARTED WITHICJ <br />18 DAYS OF D E FERM�T IS ISSUEC AND THFREAFTER IS TO <br />B DILIGENTLY PURSUED TO COMPLEl'ION. THIS PF.RMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE Of WORK ON THIS <br />PROJECT OVER 90 DAYS DURATlON. <br />