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Date���s <br />Application For <br />P�BLIC WORKS PERl1AlT <br />Print or Type Only <br />Describe Proposed Work <br />Pro�ect Address (if known) <br />Pe�lic WorY.s Pe�r.m`il s ✓{ �`/��/�//U� `7 <br />Bldq. UepL + �L � / J "T � <br />Foehc w,rxs Fce S <br />Total Fee <br />less A00� Fea Pald $ <br />f3TIdfICB �U9 .1 <br />City Llp F'none <br />A�tach four (4) copies ot plens for proposed work - Draw lo scale and note the following as appiicaMe: <br />• Properry Lines • Centerline of street <br />• Outline and dimensions ol all existing an�� • Indicate North <br />proposed structures on the iot • Show any proposed grading changes <br />• Existing and proposed ulilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259-881 5. <br />2. Ail work shal� be performed in accordance with this permit and current Ciry of Everett Design and Construction <br />Standards and Specilications <br />3. Cail Location Underground Service 48 hrs. belore you dig. 70LL FREE NUMBER 1•800•424-5555. <br />�'��/��✓ O�� -.> <br />Approved for Const ction'^`%� ale <br />/ �•�� —I�—�� <br />AL INSPECTION Date <br />Approved as Construcied <br />everett PUBLIC WORKS DEPAR7MENT <br />� 3200 Cedar Street <br />Everelt, WA 98201 <br />Phone: 259-8815 <br />�6 9 <br />ACKNOWLEDGEME�T OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hareby agrees lo hold and save harm• <br />less lhe City of Everetl Irom any and all claims br damages, costs. <br />expenses, or causes of action thal may arise because ol installation <br />and maintenance ol the imUrovement or other right-of-way use hereto <br />applied br and lurther agrees lo remove same upon notice irom the <br />City 2nd}o re�ace public property damaged thereby. <br />,t�ORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND TIIEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />Z <br />O <br />� <br />.. <br />C'> <br />m <br />.. .� <br />--1 �7 <br />..-� � <br />N 2 <br />0 <br />m <br />co <br />mo <br />-� c <br />O 3 <br />-� z <br />x --i <br />m <br />o z <br />c <br />a -a <br />rx <br />�. «. <br />—{ N <br />i <br />O A <br />-n a <br />-� m <br />x <br />m �-+ <br />N <br />0 <br />om <br />c v+ <br />3 N <br />m <br />z t� <br />-� r <br />• m <br />a <br />A <br />� <br />S <br />a <br />z <br />-� <br />x <br />N <br />Z <br />0 <br />� <br />.. <br />n <br />m <br />