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Date�;�� <br />Application Fur <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />r0� rt/C- S,. � fi <br />Mailing Address <br />Describe Proposed Work <br />Project Address Qf known) <br />'Lip <br />Public Waiks Permit t_�� C-97 <br />eieo. oea. • ��.— <br />Public Works Fee $ <br />Total Fee <br />Less ApO� Fee Paitl $ <br />Da:anco Due $ �S�o — <br />Attach four (4) copies of plans !or proposed work - Draw to scale and note ihe following ac applicable: <br />� Property Lines .• Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed slructures on the iot • Show any proposed grading changes <br />• Existing and proposed utilities ! Show measurements <br />PERMIT CONDITIONu <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current Ciry of Everett Design and Construction <br />Standards and Specifications. <br />3. Cail Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />cS'��.e ��J�' �a .fw -cer��,a���o�,Q.ce�.rrla�al�zre� <br />��G�v C,� 8 2i�-8' <br />`�r.� ��� B/28�97 <br />Approved for Construction � � te <br />FINAL INSPECTION ` ' ` Date <br />Approved as Constructed <br />everet[ PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone: 259-D815 <br />\. <br />W <br />H <br />� <br />� <br />� <br />� <br />L'L�/:i�_�il`t _ 'ai'^ ...,� ;�`i,t': - � <br />/ � � <br />I',ii�018G60 <br />I'.LDG ' 2i33S.5�� O <br />i; S4:i:li Ej.SU <br />i_ 5h'CH :15.�0 <br />�1r:VIJ'; 9::�.u�' a <br />li IOD: E.�16 <br />SEGf[;' :30.0�_' <br />_'17I :i `'207.?z <br />ACK'JOWLEDGEfvfEIJT O��ONbIYlON3 <br />The undersiyned owner/aFPlicant hereby agrees to hold and save harm- <br />less the Ciry of Everelt frum any and all claims for damages, costs, <br />expenses, or causes of action thal may arise tecause ef installation <br />and maintenance ot the improvement or other right-of•way use hereto <br />applied for an� further agrees to remove same upon notice from ihe <br />City end to r place public property damaged thereby. <br />�� � .��,� �/� <br />ignaturs of Apolicant D3te <br />WORK AUI�NORIZED BY THIS PERMIT M�: T BE STARTED WITHIN'''/// <br />180 OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS� <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAY <br />CANCELLED 6Y THE CITY UPON ANY STOPPAGE OF WORK ON: <br />PROJECT OVER 90 DAYS DURATION. � <br />