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�� � <br />n. <br />oe�e.� U <br />Applitation For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�A.. L=�.�.�n-- <br />Atldress . City <br />Pu�Gc Worb Perm�ll �' / , <br />BItlQ. DeO�. � �f�[ LiS��1 <br />-—/+' <br />PUEIi< WaAe Fee <br />Talel Fee : — <br />Less AvO� Fee PaiC S <br />Belanee Due f <br />�S� -�� = <br />Applir�nt Mailing Address City Zip Phone <br />Deac�ibe Proposed Work CrxsTiu� 1 i� � � r�c v— JS,� o �eX' l' c l��iu . Lf). <br />Preject Address (il known) <br />Attnch four (4) copies of plans (or proposed work • Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• OuUine and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities � Show measurementc <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs in advance - phone 259•8815. <br />2. All work shell be pertormed in accordance with this permit and current City of Everett Design and Construction <br />Stantlards and Specifications <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />Na /7(�J / E•E%Ji/T � f rii.F r: .O <br />� .S-< < - �' G <br />Approvedfor ConstrucHon Date <br />FINAL INSPECTION Date <br />Appraved as Constructed <br />everett PUBLIC WORKS DEPAHTMENT <br />� 3200 Ceder Street <br />Everett, WA 38201 <br />Phone: 259•8815 <br />`, ,l^/F. <br />ACKNOW�EDGEtiIENT CF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owneqapplicant herehy agrees to hold and save harm- <br />less the City of Everett irom any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of inslalletion <br />and mainlenance of the improvement or other right-oi•way use hereto <br />applied for and further agrees to remove same upon notice froin the <br />City and to replace public property damagetl thereby. <br />J �� ,`h 7;�>��',lz._��.. G �5� �� <br />Signature of Applicant �� Date <br />WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br />180 L�AYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />9E OILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br />CAfJCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PFOJECT OVER 90 DAYS DURATION. <br />