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4 <br />i <br />.. _ �_--� __ ._ _ —____ _ ____ <br />--�{ �i____.—__ __-.--_'_—'___ ".,s- . <br />,.. . �: �,: .. .. �.. ., • �. ,. � ... . . , ,. ,. _.,� �. . . . . .. . . . . - . .. - _ � <br />Date?/� <br />PUBLIC <br />Print or Type Only <br />Owner <br />sc <br />' �..,. � I/ I I r I��l <br />TO POSTING___�� � �PuOLeWorksPermit• ��', __ <br />�q eiag. oaoc . 37575 <br />Applic�!ion Fo� � <br />WORK� PERMIT PublicWoi�sFee s <br />r� Tolal Fee <br />LY Q Less A00� Fee Peitl S _ <br />S � �; �'-✓ � � Balance Due .S ��'� <br />4 . <br />$' �`.��� �;o <br />.n er n� <br />* :e <br />If: P <br />r� :x s c� cu <br />ey rn . � :,� <br />�ti�pcxw <br />Zip Phone <br />O�er <br />Applicant Mailing Address City Zip Phone <br />Descrihe Proposed Work <br />ir <br />Project Address (if known) �+� �^ a•�'��� '�� ^nY <br />� <br />Attach four (4� copies of plans for proposed work - Draw to scale and note the following as applicable: <br />•�:ae«.... • Property Lines • Centerline of street <br />_��- • Outline and dimensions of all existing and • Indicate North <br />.�_ proposed struGures on the lot • Show any proposed grading chanqes <br />� • Existing and pF�oNosed utilities • Show measuremenls <br />PERMIT CONDITIO�VS <br />1. All calis for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All worlc shall be pt�rformed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. � <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />✓'!G'l"^-°•%�. ����/%' <br />Approve Constr ction Date <br />/a. /6 Y-Z <br />FI L INSPECTIO � Date <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everet6 WA 98201 <br />Phone: 259•8810 <br />ACKNC�WLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner; applicant hereby agrees to hold and save harm• <br />less the City of Everetl from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other righl•oF-way use hereto <br />apnlied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged there6y. <br />�'�„ t-� i'�,�,. �`��!- �/z_ <br />Si nature of Applicant �� Date <br />WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT I.�i ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON AN'f STOPPAGE OF WORY, ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />