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r <br />L <br />I '� <br />Application For <br />PUBLIC WORK� PERMIT <br />Print or Type Only <br />3//�S�- 3�= Cv.�S � <br />Mailing <br />Public Wcrks Pe� il ♦ `� T '� <br />eioe� oco�. � � <br />P�on� wo�k� Fee S r � 3. �.• Z <br />Tolal Fee <br />Less Appl Fae Peitl S <br />eaience Due § , � 3• �'' L <br />��..,..�:,c ree — f�i2c�.Si <br />� w� � a,y �3�-, �� <br />'Lip � Phone <br />City L+p rnone <br />Describe Proposed Work � '",�=i-�-�� '��a'--\ ��� � <br />Prolect Address (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline ol sireet <br />• Ou�line and dimens�ons ol all existinp and • Indicale Norih <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS � <br />1. All calls for inspection shall be made 24 hrs. in adeance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current Ciry ol Everett Design and Construclion <br />Standards and Specilications. <br />3. Call Location Underg�ound Service 48 hrs. before you dig. TOLL FREE NUMBER 1-500•424•5555. <br />�� WU�'k 51..a I1 �oz � e{ <br />P,,t►�i,� �ti��.1�� <br />t9r <br />FINAL INSPECTION . J \ <br />Approved as Constructed ` <br />evemtt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Strecl <br />Evoretl, WA 98201 <br />Phone: 259-8815 <br />-i1 -�Y <br />�la� -� <br />�- �� -�y <br />��(�Ov•J/ �� <br />, <br />W <br />H <br />� <br />� <br />� <br />� <br />� <br />� <br />� <br />a <br />ACKNOWLEDGEMENT OF COP:OITIONS <br />The undersigned owner/applicnnt hereby agrees to hold and save harm- <br />less the City ot Everett Irom any and all claims lor demages, costs, <br />expenses; D es ol action thal may arise because of installation <br />and maintenance o ihe� imp�emept or other right-ohway use herelo <br />applied for and lur er a es to removo same upon nolice trom the <br />Ciry and to repla publ' propert ��there6y. <br />� <br />Sign� re of Applicant � �-� Date <br />WfdRK AUTHORIZEp'BY THIS P RMIT MUST BE STARTED WITHIN <br />�(80 DAVS OF DATE PERMIT ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED T COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY TH�E QITY PON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAl'S DURATION. <br />J <br />� <br />M� <br />� <br />