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Dafe�� <br />Applicatinn for <br />PUBLIC WORKS PEf�IMIT <br />P�int or Type Only <br />Mai�i <br />Publm WO�ks Permu � % // ___. <br />E'n9 DePt ��� 1 O�`IS7._'—_ _ <br />Fubl¢ YJorks Fea <br />Total Fce S <br />LessApc�. Fee Paia S <br />e�m��� o�� <br />�� 7 Lc�l� ���—�--� � I�9�1E� �r� Q�P3Q� �(c �— R 1���� <br />Appiican� A9adin9 Address Ci�y Lp Phone <br />Descrlbe Proposed �1brk �e;j.1]12.L_Lk'il�h�� >.i r��N! /�! /rl / �i(7 �/ni.p <br />Projr.ct Address 1i1 known) _ 7i7J .SC �U('1 <br />Attach fuur �4� copies ot plans for proposed work � Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions ol a'I existing and <br />proposed StruCtures on Ihe lot <br />• Existing and pwFosed utili�ies <br />• Centerline ol street <br />• Indica;e North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calis for inspection shall be made 24 hrs. in advance • phone 259-8810. <br />2. All work shall be performed in accomance with this permit and wrrent Ciry of Everep Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL PREE NUMBER 1•800-424•5555. <br />/ � / ��F�jC '-C 2<c� •/ <br />fl',! �; �c.�� <br />�J G%—ZG-89 <br />.� �� x <br />F <br />.�� <br />Approved for Construction Date <br />FINAL INSPECTION <br />Approved as Constucted <br />everet[ PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everett, WA 98201 <br />Phone: 259•8810 <br />::t.s.,,�,-� . <br />3 ; . <br />� ���'t '' i._: <br />i; yt <br />'_ i, . <br />r'a.� �� <br />..:i..''.."yY:l.:�'�. <br />..r _.`� �. i. .. � <br />Date <br />. . -. .1,;�.. <br />ACKNOINLEDGEMENT OF CONDITIONS <br />W <br />� <br />_ I <br />� <br />� <br />� <br />N <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and savc harm- <br />less ihe City of Everelt from any and all claims for damages, cosls. <br />expenses, cr causes of action that may arise because of installation <br />and inaintenance ol ihe improvement or other right-of•way use hereto <br />applied tor and Grlher agrees to remove same upon notice Irom Ihe <br />City and to replace public property damaged �hereby. <br />Signature ol Applicant Date <br />WOFiK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUEU AND THEREAFTER 15 TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCEI.LED Bl' THE CITY UPON ANY STOPPAGE OF WORK O�J THIS <br />PROJECT OVER 90 DAYS DURATION. <br />