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Date -LL'�i1 <br />Application For <br />PUBLIC WORKS PERMIi <br />Print or Type Only <br />W � U9 c'�EL� <br />� �or,,,,�, <br />C.[1.Ei*� UN10�J �-8�-1 �� <br />Mailing Address <br />PuOhtWorksPermli• �j ����� <br />Bloa. Deol. • <br />Public Worka Fee s <br />ToulFee <br />Less Aool Fee PaiE S <br />Belance �ue s �� <br />p��.� 1 002-33Z-Yo -oao-l38> <br />ov�nz �ca_n�,t1 , <br />DescribeProposedWork CL�L UF«��� /,SZ aG, <br />' ?�o;ect Address (if known) <br />Atlacii four (4) copies of plans lor proposed work • Draw to scale and note the foilowing as applica6le: <br />• Property Lines <br />• Outline end dimensions of all existing and <br />� proposed structures on the lot <br />� Existing and proposed utilities <br />• Centerline of street <br />• Indicate North <br />� Show any proposed grading change� <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hra in advance • phone 259•8810. <br />2. All work ehell be performed In accordance with this permit and curtent City ot Everett Design and Construction <br />Standards end Specifications. <br />3. Cell Locatlon Underground Service 48 hrs. before you dig. TOLL FNEE NUMBER 1•8i)0�4245555. <br />� r� .�2,n�,� C�,�.�u��,� -�,c��.� <br />��.,.��,,,0 //�za� �.� : � ,c.��.;n.� <br />� ����� ����� �� <br />S� �.,,�.. �,�..--� �.�.�„� <<� <br />�.�, �z� d�. <br />�. �.,� <br />y��� <br />I> �a�.e �e` �4� sc�� <br />� `�-�,�„i <br />�� � <br />7, �ilov�coQr. ��a.sc�--- co.�.�nv-F' <br />�v�'w waziaz f�ja�a,E`Z. <br />�%:�.��_ /or/a �: <br />Approved for onstruction , ate <br />FINAL INSPECTION Late <br />Approved as Construcletl <br />����PUBLIC WORKS DEPARTMENT <br />3200 Cetlar Street <br />Everetl, WA 98201 <br />Phone: 259•8810 <br />.a�e2 `.�,��' <br />�� fe�^a'- <br />� � <br />�,,�'�.Z. c r�6 <br />�,,��.,��. , <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />les� the City of Everett from any and all claims for damagea costs. <br />expenses, or cavses of action ihat may arise because of installation <br />and maintenance of ihe improvement or other right•of-way use hereto <br />applied for and further agrees lo remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHI� <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 6E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />