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Date� �L�p % <br />AppliCation For <br />PUBLIC WOF�KS PE�iMIT <br />Print or Type Only <br />;t I �7 # <br />Address <br />Address <br />Cit�' Zip <br />Pu�lic'Norks PQermil s � • � ���� <br />�I49. OeOt. s � >� ���j_ <br />Public Waks Fee <br />Total Fee $ <br />LessAo�l. Fee PeiO S <br />Balunce Ilue s �0 �� <br />Describe Proposed Work ����� �i� i /�l 1 / �'�A ) ._��� IS � �( I i � <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicahle: <br />• Proparty Unes • Centerline of street <br />• Outline and dimensions o( al� existing and � Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existfng and proposed utilities • Show measurements <br />Approved <br />PERMIT CONDIT�ONS <br />Phcne <br />7. All cails for inspection shall be made 24 hrs. in advance - phone 259-8815. <br />2 nIl work shall be performed in accordanca with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Ca�l location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />'.��, TiG//�. L,�vE /POOF—TC�P 1)O[cJN-Sr�ovT-S' /�t/To �/19/�/9G� <br />SJ/sr�M S//�u��v n.� 9A>9cy.F� C•f/�.eT. <br />hINAL INSPECTION <br />Approved as Conshucted <br />everett l P�9LIC WORKS DEPAR7MENT <br />Q 3200 Cedar Streel <br />Everelt, WA 98201 <br />� Phone:259•8815 <br />Date <br />P,CKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The under5iyned owner/applicant hereby agrees to hold and save harm� <br />less ihe City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because ol instaltation <br />and mainlenance ot Ihe improvement or other right�oFway use nereto <br />applied lor and further agrees to remove same upon notice from ihe <br />(City and to replace public p�operty damaged thereby. _ <br />l�. _�� � � ��1 !� 1��� 6',%� <br />Sig6ature cf Applicant � Date <br />WORN AUTHORI2ED BY THIS PERMIT MUST BE S ARTED WITHIN <br />130 DAYS OF DATE PFRMIT IS ISSUED ANU THEHEAFTER IS TO <br />F�E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 9E <br />C�NCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. — <br />