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Date�1� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />v ��r r� � <br />Maifing Address <br />/.s��� - i �a�; <br />Mailing Address <br />Describe Proposed Work � d I?�' d- / ��%i� <br />Proiect Address (i( known) <br />Zip <br />Zip <br />Publm Worke Per ♦ {� c�/ <br />Bldp. Dept. r �V �,/ �i�� <br />� <br />PuElic Works Fee <br />Totel Fe¢ S <br />Less AOP� Fee Pa'�9 $ <br />eamnce Due 5 <br />Attach four (4) copies ol plans for proposed work - Draw to scale and note the following as appiicable: <br />• Property Lines • Centedine of sireet <br />• Outline and dimenslons of all exis:ing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITfONS <br />t. All calls for inspection shall be made �' hrs. in advance - n��one 259•881 5. <br />2. All work shall be performed in accordance with this permil and current City ol Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Underqround Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />� T,L/b'C�/C- lG�C'G,C f�E,�'.fi�/T ,��U/.�=E� <br />�� �� S' c`7�s <br />Approved lor Construction Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everett, WA 98201 <br />Phone: 259-8815 <br />: • <br />-- �,o� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />�• <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees lo hold and save harm- <br />less the City of Everett Irom any and all claims lor damages, costs, <br />expenses, or causes of adion that may arise because of installa[ion <br />and maintenance ol lhe imp�ovemenl or other righl-ohway use herelo <br />applied for and lurlher agrces to remove same upon notice from ihe <br />City and to replace public property damaged lhereby. <br />Signa�ure of Applican� Date <br />WORK AUTHORIZED 6Y THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PEfiMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />z <br />0 <br />-� <br />c�''� <br />m <br />... .. <br />-i -n <br />.. .� <br />N S <br />m <br />0 <br />co <br />m� <br />-� c <br />03 <br />_ -�i <br />m <br />o z <br />c <br />n -a <br />rx <br />.. .. <br />--1 v+ <br />< <br />o� <br />'*t 3 <br />=m <br />m .-+ <br />N <br />O <br />om <br />c <n <br />3 tn <br />m <br />z c� <br />.� m <br />a <br />� <br />� <br />x <br />s <br />z <br />� <br />x <br />N <br />Z <br />0 <br />� <br />� <br />m <br />