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��� <br />�y <br />;yH <br />� � � <br />H� <br />��Q� <br />x <br />�H� <br />��g <br />(�] Y �] <br />zH <br />i-+ <br />gyy <br />C��f�A <br />�Hf/� <br />HUCA <br />I ��' <br />i � �� <br />i' �� ! <br />�+f. <br />Date � "�� " ����� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�/— <br />�� <br />� <br />Pul�Lc \Yo�ks Pmmit � (/�,/9 a <br />�Ido Dept � ��% / J — <br />. ���f— <br />Pubfm Woiks Fea g ��!, +^ <br />ro„� F�o <br />LeasApoLFeePm� 5 ��)�� <br />9�ia�ou cuu S <br />Owne� / MailingAtltlress ���r "� � ��-��- <br />I�VI� STT"�M1�1� �ro I ST Av s►�404 S�lfi�� 98104 Gz8 0lll <br />Applicant Mailing �ddress Ciry Zip Phone <br />Descri6e Proposed Woik <br />Project Address (il known) <br />Attach low (4) copies ol plans lor proposed work - Draw to scale and note ihe lollowing as applicable: <br />• Properry Lines .• Centerline ot stree� <br />• OuUine and dimensions ol all existin9 and e Indicate Norih <br />proposed strucWres on Ihe lot • Show any proposed grading changes <br />• Existing and proposed ulilities • Show measurements <br />PERMIT CONDITIONS <br />t. All calls (or inspection shall be made 24 hrs. in advance - phone 259-881 5. <br />2. All work shall be perlormed in accordance with this permi� and curreM City ol Everett Desi9n and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800•424-5555. <br />�( . / , <br />� � . .�U -�� � <br />� ��.: - �,c�����G�'- ,f_���I.,..s <� � c . _ <br />/� <br />A p ve for onslr ion ^ Date <br />Ec�-k,,, � 9 � a ��� , <br />FINAL INSPECTION Date <br />Approved as Constructed <br />evereu PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phone:259�8815 <br />ACKNOWLEDGEMENI' OF CONDITIONS <br />W <br />H <br />� <br />N <br />�w <br />Y/ <br />O <br />a <br />The undersigned owner/applicant hereUy agrees to hold and save harm- <br />less lhe Ci�y ol Evere�t from any and all claims lor damages, cosls, <br />ezpenses, or causes ol action that may arise because ol installation <br />nnd maintenance ol thei�nprovemeM or other ric�ht-of-way usa herr.to <br />applied lor and lur er apree ip rcrt{dve same upon natice Irom the <br />City and to replqc puBlic pw�arly d�maged thereby. <br />i f <br />�r: �`�,, n' . %si� �/�'���7 <br />� � �(!% <br />Signature � ic�snt_.�� � ate <br />WORK AUTHORIZED BY 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 PERMIT MF�Y BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />