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��vsr <br />% <br />x��i <br />�� � <br />a � <br />Y Hx V� <br />Hz� <br />1'C � <br />� � � <br />L,J � � <br />H t7 <br />H�g <br />� Y (� <br />t"y� <br />HH <br />g� <br />�e� <br />��� <br />zy�n <br />HOCn <br />�� <br />Date yr y/ <br />t'" ` <br />Application For <br />PU�LIC WORKS PERMIT' <br />Print or Type Only <br />up <br />:9:, <br />PoElic Warxa Permit • <br />eic�.oaoi.e�'� 7 3� `/ <br />VuolmWorkaFea $ <br />Totel Fea <br />Laf� Appt Fea PaiE 5 <br />�alance Due S <br />Descri6e Proposed Work i Ye a SE / ,�?�� .�--�-� C✓�^-,� ���� <br />Prolect Address (il known) <br />Attach tour (4) copies of p�ans lor proposed work - Oraw to scale and note Ihe lullowing as applica6le: <br />• Property Lines • Centerline of street <br />• Outline and dimensions ol all existing and • Indicafe Norih <br />proposed strt �tures on the lot • Shcw any proposed grading chenges <br />• Exisling and aroposed utililies • Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor Inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />S�andards and Specificaticns. � <br />3. Call Location Untlergrour�d Service 48 hrs. before you dlg. TOLL FREE NUMBER 1•800•424••5555. <br />Il�f � �c�v�fG�� <br />V" <br />�.k.,R <br />r� ?-lC�-�l <br />Approved for Construction Dale <br />FINAI INSPECTION Dale <br />Approved as Constructed <br />����PUBIIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everelt WA 98201 <br />Phone:259�8810 <br />� <br />C <br />s <br />D <br />� <br />� <br />ACKNOWLE�GEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less the City of Everelt Irom any and all claims for damages, costs, <br />expenses, or causes ol action that may arise 6ecause of installation <br />and maintenance ol the improvement or other right•of•way use hereto <br />applied lor and lurther agrees lo remove same upon notice trom the <br />City and lo replace public property damaged there6y. <br />Signature of Applicant Dale <br />WORK AUTHOflIZED BY THIS PERMIT MUST BE STARTED' WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THcREAFTER IS �TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />� <br />