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e <br />L�: Cn � <br />ay <br />�oxx <br />'�" H <br />ay5�n <br />y 5H <br />� H� <br />O x0 <br />'i1 H `� <br />f/1 H <br />[�1 O � <br />H t7 <br />�/��g <br />y� V Cq] <br />za H [�f <br />rHH <br />� <br />H <br />C� C7 �n <br />��M <br />y0� <br />�� � <br />Date -r S -� � <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Prinl or Type Only <br />/�i � - L>, <br />Ciry <br />n- <br />Pum�c Worka Permit • . <br />oine DeOL• _. <br />Puelic Woiha fee <br />Tolal Fea $ — <br />Lese Aoo�� Fee PaiO $ <br />Balanco Doe $ <br />.�i�in,cY, <br />Applicant Mailing Address City 2ip Phone <br />Describe Proposed Work �'�'Y��--� - `r�''�' �- <br />Project Address (if known) � � � _' � <br />Ntach lour 14) copies ol plans lor pmposed work - Draw to scale and note Ihe lollowing as applicablc <br />• Property Lines • Centerline of sireet <br />• Outline and dimensions of all exislinc� and • Indicate North <br />pwposed siructures on tne lot • Show any proposcd gradiny :han3es <br />• Eaisting and proposed utililies • Show measuremenis <br />PERMIT CONDITIONS <br />1. All Cnlls for inspeCtion sha�l be made 24 hrs, in advance • phone 259•8810. <br />2. All work shall be pedormqd in accordance wilh lhis permi� and current City ol Everett Desi�n and Consiruction <br />Standards and Specificalions. <br />3. Call Location Underground Service 48 hrs. befor� you dig. TO�L FREE NUMBER 1•800•424-5555. <br />! ' 1t <br />�� � <br />�4=�(!'i�l.G�� _'`.L.�GJqic. (�'�� [�%,.�:!l�vcCC :(C1 � <br />Py ( ���jj' <br />� �'�"/i.: = <br />�i� <br />� .:� :� <br />�'� <br />�pproved for Construc�ion Date <br />FINAL �NSPECTION <br />Approved as Consiructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreet <br />Everett, WA 98201 <br />Phonc:259�8810 <br />W <br />� <br />��w <br />M / <br />� <br />O <br />♦�^ <br />V♦ <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersi9ned owner/applicant hereby agrees to hold anA save harm� <br />less the Ciry al Everett irom any and all claims lor Jamages. costs. <br />expenses, or causes of aclion Ihat may arisc because ol installalion <br />and maiNenance ol the improvemenl or other right-ol•way use hereto <br />applied for and lunher agrees to remove same upon notice Irom the <br />Ciry and to replace public properry damaged ihereby. <br />Si9nature ol Applicanl Date <br />WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIr MAY BE <br />CANCELLED 8Y THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />�. <br />