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� / <br />� n�v� <br />+� r'�(�' � Gub�ic Works Permit a �/T'W <br />Date �,��2� � <br />.-� Application For emB. oau�. • � 2--�1 <br />d — <br />PU�LIC WORKS PERMIT P°°"<W°"SFeB s <br />Toial Fee <br />Less Appl. Fee PaiA S <br />gj � g y�j p � p O O O Balance Due S ZO � <br />Print or Type Onl _(�'' �� <br />� � � � � � � M �� ���T��c L <br />� N ry +P . _ W � W .M�.� <br />_ r+ M � � �.. _ .. if�—� ._ � . <br />Owner <br />Mailing Address <br />Describe Proposed Work <br />Project Address (if known) �7z" <br />Cify Zip <br />City <br />p, c� �F L�"[MI NU sTC�' <br />Atlach focr (4) copies of plans for proposed work - Draw ro scale and note the followiny as applicable: <br />• Properry Lines • Cenlerline of street <br />• Ou�line and dimensions ot all existing and • Indicate Norlh <br />proposed siructures on the lot • Show any proposed gradin9 changes <br />• Existing and proposed utilities • Show measureme�ts <br />PERMIT CONDITIONS <br />1. All calls for inspection shell be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be pedormed in accordance with this permit and current City of Everetl Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-500-424•5555. <br />1// <br />�c2�.�Q. �M C�c�_ B-Z�--�O <br />Approved for Con r tion Date <br />%�.%�C-� �j -� l L-- <br />FINAL INSPECTION Date <br />Approved as Consirucled <br />everett PUBLIC WORKS DEPAR7MENT <br />� 3200 Cedar Street <br />Everett. WA 98207 <br />Phone: 259-3870 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <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 Cily ol Eveiet� irom 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 right-of•way use hereto <br />applied lor and further agrees to remove same upon notice from the <br />City and to/eplace public property da�aged thereby. <br />SigdaKre of Ap I�anN ���� <br />WORK AUT RIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS F DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BF <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />