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� � � <br />H <br />�H� <br />K�n <br />H �1 <br />'�1 H '?1 <br />[/] Hr <br />L�7 O t+7 <br />� d <br />O �"I�y <br />HC�s1f� <br />�Y (] <br />�H� <br />HH <br />gy <br />H <br />CC] C f/� <br />[�7�M <br />HOtyi� <br />��� %° » 3`S vh <br />t :':. � rs.��'''' . <br />�t y � .s ;� � '.', <br />__�ih!'� _ _ � _ ��• '`�a� .-.. < < . - . �Q�s�acn�� ' <br />�i..w . :......... . .. ,_, <br />,-..t . -- i <br />Date �' -X' <br />Application For <br />PUBLIC \IVORKS PERIVIfT <br />Print or Type Only <br />�;1_• - <br />Owner <br />�, / <br />Applicant <br />Describe FroposeG Work <br />Proleci Address lil known! <br />ng <br />Mailing Nddress <br />� ; <' i <br />'�c_- c' ; r„ '�_ <br />City <br />Ciry <br />�: _i�.:'r � C4=, <br />r" � PueLc Works Perm11 • <br />. , eiaa.o�oi., ' � ' � ��`S <br />Puplic Wo�ks Fee <br />To�al Fee $ <br />Less Appt Fee Pa0 $ <br />Baiance U�e S <br />'i:�V /;.�:. �_l _.. _. "'l -��i(� <br />Zip <br />Allach four �A) copies ol plans for proposed work - Draw to scale and note the lollowing as applicable: <br />• Prope�ty L�nes Y Cer,terGne of sireet <br />• OuUine and dimensions ol all existing antl • Indicate Nor�h <br />proposed structures on the lol • Sho�v any proposed r�radiny chanyes <br />! Existing and prnposeA u�ilities � Show measuremen�s <br />Phone <br />PERMITCONDITIONS � <br />t. All calls lor inspedion sh�ll be matle 24 hrs. in advance- phone 259-8810. <br />2. All work shall be peAormed in accordance wlth thic permit and current Ciry ol Everett Design and Construction <br />Sto�dards and Specifications. . <br />3. Call �ocation Underground Serv;�e 4tl hrs. before you dig. TOLL FHEE NUMBER 1-800•424-SS.riS. <br />�,i <br />/ C�� �'f_ �✓�6� ii /' i' /`�-i. �✓....♦ � / :�I( �`(A .� ._L!�� <br />' i I "� ..l ��') � J'• i �'�� <br />/ � � '/ <br />Consiruction <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant herr.by ac�rees to hold and save harm- <br />less the City ot Everett from any �nd all claims lor damages, costs. <br />ezpenses, or causes of action ihat may arise bewuse of installation <br />and maintonance M �he improvement ur other righ4of-way use hereto <br />applicA to: and lurlher agrees to remove same upon nolir,e Irom ihe <br />Date City and lo replace �ublic property damaged thereby. <br />FINAL INSPECTION Date <br />Approved as Construcled <br />evereU PUBLICWORKSDEPARTMENT <br />� 32COCedarStreet <br />Everett, WA 98201 <br />Phon¢ 259�BD70 <br />Signature ol Applicant [7��r <br />WORK AUTHURIZED BY THIS PERMIT MUcr 0h STFRTED WITNIN <br />180 DAYS OF DATE PERMIT IS ISGUED ANC/ THEREAFTER IS TO <br />BE DIUGENTLV PURSU6D 10 COMPLETIOtJ. THIS PEFiMIT IdAY BE <br />CANCELLEU B'! THc CITY UPON ANY STOPFAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DUR�TION. <br />