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� � <br />H <br />9 H C/� <br />H �� <br />� H� <br />h�C M'�I <br />�p M <br />x <br />��o <br />��g <br />�V � <br />ry�H <br />N <br />g�y <br />�H� <br />H O tn <br />��� <br />� <br />Date I�1—�� <br />"'_-���� _ . . <br />� <br />ApplicaUon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />_.___.__ _'_— _ - ___.____ . � .-1 <br />� <br />� Pu�4c WorFs Per <br />eiae o.oi.. ��1 '�� <br />PubliC W OIMS i CB <br />TOIaIGen. S <br />Lass Appl iee Vai� S <br />�dId11CC011P S <br />Describe Proposed Work <br />� <br />Maiiing Aaaress <br />�-> >v�_ . <br />.II-.�J�nV I�? <br />Attach lour (4) copies ot plads IoYpmpos �work - u aw �o�scagie anp <br />• PropertyLines r_�;��� �i�� �ti� ��'J`C.� � <br />• Outline and dimensions all existing and� � <br />proposed structures on the lot <br />• Existing and proposed uiili�ie5 <br />[4s <br />��C8rde11'iire o� G et�Lfi'� �.��� /� / <br />• Indicate North <br />• Show any proposetl grading changes <br />• Show measurements <br />rnone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pedormed in accordance with this permit and curren! City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />li��%'l %1�"`�� . <br />� <br />, , <br />���,.��� <br />_-�� <br />.�: -� <br />Approved br Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everet[ PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everet�, WA 98201 <br />Phone:25y8810 <br />/ <br />W <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owneqap0�icant hereby agrees to hold and save harm- <br />less the City of Everett irom any and all claims for damages. costs. <br />expenses, or causes ot action ihat may a�ise because ol inslallation <br />and maintenance ot the improvement or other righ4ol-way use hereto <br />applied for and further agrees to remove same upon no,tice Irom Ihe <br />City and to replace public properry damaged tneieby. <br />Signature oi Applicant Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEPEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF �VORK ON THIS <br />FROJECT OVER 90 DAYS DURATION. <br />A:TL^4$ <br />9 <br />{j <br />