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, <br />.e�6 <br />Applicr.;ion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� <br />Address <br />PUEGc Y/arMs Permlt • <br />sme. oao� + — <br />PUEIIc Warka Pea S <br />Tolal Fee <br />Le:s Appl Fee Pald $ <br />Balance Due $ <br />pagu,oa.0 CVi,i�F� 9y2a <br />City Zip Phone <br />(c.�a,e ��3ss -.37�0 <br />r�E ¢ �,+ LJEO, <br />Giry up <br />Describe Proposed Work �"'�� ��""� G""��` "'�'�- 2 m f� �^'�'4 <br />Pro�ect Address (if known) <br />lUOOCI <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines • Centerline ol street <br />• Outline and dimensions of all existinc� and • Indicale North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existlng and proposed utilities • Show measurements <br />PERMIT CONOITIONS <br />1. All calls for inspection shall be made 2a hrs. in advance - phone 259-881 5. <br />2. All work shall be performed in accordance with this permit and current City of Evervit Design and Construclion <br />Standards and Specifications. <br />3. Call Location Underground Service 4B hrs. before you dig. TOLL �R�E NUMBER 1•800•424•5555. <br />Approved for Construction <br />Datc <br />FINAI. INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98207 <br />Phone:259-8815 <br />�S <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />The undersi�ned owner/applicanl hereby agrees to hold and sava harm- <br />less lhe City ol Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise bewuse of installaGon <br />and mainlenance of the improvemeM or other right-obway use herelo <br />applied for and further agrees to remove same upon nolice trom the <br />Ciry and to replace public property damaged thereby. <br />Signalure of ApF icanl � Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STAfiTEu \rvITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DIIIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY E3E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />� � <br />..� .-1 <br />N 2 <br />0 <br />m <br />co <br />mo <br />-a c <br />O 3 <br />m <br />i —�i <br />m <br />oz <br />c <br />r = <br />—1 N <br />� <br />� <br />O A <br />�a <br />3 <br />—i m <br />x <br />m �-. <br />� <br />or <br />�m <br />3 tNii <br />m <br />z c'� <br />�r <br />• m <br />a <br />� <br />� <br />_ <br />a <br />z <br />� <br />_ <br />.. <br />N <br />2 <br />O <br />1 <br />n <br />m <br />