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.�� .e 4/9/,�6 <br />� � <br />Application For <br />PUBLIC WORK!3 PERMIT <br />Print or Type Only <br />�i <br />Pu01ic Warks Permll • l�.� <br />eiaq. oAui.. � <br />Puphe WorNs Pee <br />Total Feo S <br />Lass ApP� Fea Peid $ � <br />BaianceDue S -S-7z� <br />Describe Proposed Work <br />Project Address (il known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the tollowing as applicable: <br />• Property Lines • Centerline ol street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities - • Shuw measurements <br />PERMIT CONDITIONS <br />1. �II calls for inspection shall be made 24 hrs. in advance - phone 259-881 5. <br />2. All work shall be pertormed in accordance v�ith Ihis permit and current Cily ot Everett Design and Construction <br />StanCords �nd Specifications. � <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBEF� 1-800•424•5555. <br />� �/0%'<!C'.�/f% %�cJ /11Z� � Sf,���G /i�'06 i� S Tv�E'' '/ <br />�-'�'�„�.t� C'yLC'vc,yTlo�J .9•t.tfl �i9y v,�,Q��,r/,�G�= <br />'� sTv /' cJo,�i� p.C��c <br />�« �` 9/� ��6 d� � � <br />���icc ���= �'�s�T�o .�i c�nzsT�:-C'TIo,J �s�rr—.. <br />s f.'F'."��c�9�J:�o�.r��2-=� s/�.9i� /���.r� <=�✓G'/n.�cc.`,`� <br />GG%/ClTf/ �qi'+�� //J�/'..L`,,�,��—/�'�:i-✓,T� �L7lP�� �c' ' <br />�����.� �y 9j���� . <br />YY� v��.0 u.a vv� �al� YI.ICU <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />ACKNOWLEOGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less the Cily of Everett (rom any and all claims for damages, costs, <br />expenses, or causes ob acBon that may arise because of installation <br />and maintenance of Ihe improvement or other right-of•way use here!o <br />applied lor and further agrees to remove same upon nolice irom the <br />Cily and to place public property damaged thereby. <br />� 9 �' <br />S' nature of Applicant Dale <br />WORK AUTHORIZED BY THIS PGRM MUST BE STARTED WITHIN <br />180 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER 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 00 DAYS DURATION. <br />