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��� <br />a � <br />��� <br />� M '9 <br />yw <br />x <br />o�d <br />��g <br />��-1� � <br />ZN� <br />[' y <br />M <br />gy <br />��� <br />�O� <br />Dat� <br />� Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />r ���hV� J <br />TO POSTING �'z'`1z' <br />Adtlress <br />� <br />Describe Pwposed Work �PiA/ (�L�D��.Y �- Ld� � <br />P�oiect Atltlress 1if known) <br />A c B F'C_.E '.- <br />� <br />P�ol¢ Wmks Permp s/ ,�/�� <br />ema ^ea�.• gQ��'��' �� <br />Punbc worFs fee <br />TalTl FP.e $ <br />Less aooi. Fee Pain $ <br />ar���« o�� s 2-0' <br />Zip <br />� N U ST«r <br />Attach four (4� copies of plans lor pioposetl work - Dram• to scale and note the following � s applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed siructures on ihe lot <br />• Existing and proposed utilities <br />• Centerline of sirael <br />• Intlicate North <br />• Show any p�oposed 9radii�g changes <br />• Show measurements <br />rnone <br />PERMIT CONDITIONS <br />�w1 1. All calls for inspeclion shall be made 24 hrs. in advance • phone 259-8810. <br />' 2. All work shall be peAormed in accordance with �his permit and current City of Everett Design and Construction <br />tStandards and Jpecifications. <br />� 3. Call Location Underground Service 48 hra. before you dig. TOLL FREE NUMBER 1•8�0-424-5555. <br />' 1 <br />1�/ <br />� YY �.G� O'z.Z' �� <br />Approved for ConstryCp6n Date <br />Y <br />�l'll ---- G /- > L <br />FINAL INSPECTION Date <br />Approved as COnstructed <br />evere[[ PUBLICNIORKSDEPAHTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259�8810 <br />I"� �z �i �91 <br />ACKNOWLEDGEMF.NT Of CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />� <br />a <br />The undersiyned owner/applicant hereby agrees to hold and save harm� <br />less Ihe City ol Everett Irom any and all claims br tlama9es, costs. <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other righPol�way use hereto <br />applied lor and further aqrees to ;emove same upon notice irom Ihe <br />City and to replace public properry damaged thereby. <br />' .c�c-c , .vL 2C — _y _ `�� <br />�Sigli etlre ot A licant Date <br />WORK AUT RIZED BY THIS PERMIT MUST BE STARTE� WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DIIIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BL- <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />