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��� <br />m�x <br />C, H <br />9 H l/� <br />�xy <br />yYH <br />fG C] <br />H xl <br />'��J H "i1 <br />HyCg <br />�OLT1 <br />OHd <br />��g <br />rj)� ei <br />�H� <br />�yHH <br />p � H <br />C] C7 � <br />�r�r <br />� <br />z i-3 cn <br />H O V� <br />1 <br />1 <br />...:W�:.�.� <br />Date 12 �O <br />Application For <br />PUBLIC WORK� PERMIT <br />Print or Type Only <br />Owncr <br />Pu�Lc Works Pe�mi� e ��� � <br />aiaa oeoi.. °%0�2(v 0.`0� <br />Publ¢ WOIXs Fee <br />Totel Fee S <br />�ess noPi. Fee Faie S <br />Balanco D�e $ Z� � <br />Phone <br />dwN�12 <br />Applicant Mailing Address City Zip Phone <br />Descrihe Proposed Work �'FR- <br />Project Address (if known) <br />Attach four (4) copies of plans for proposed woik - Draw to scale antl noL, the fcllowing as applicable: <br />• Property Lines • Ccnterline ol streel <br />• Outline and dimensions ot all existing and • Indicatc North <br />proposetl structures on the lot • Show any proposed 9rading changes <br />• Existing and proposed utilities • Show measuremen�s <br />�=� � <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance- phone 2$9•8810. <br />2. All work shall be performed in accordance with this permit and current City oF Everett Desiqn and Construction <br />Standards and Specifications. <br />3. Call Loca�ion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�-kR..� yz - s�- 9 <br />AnP�ovedforConstr •tion . Date <br />.��� 3-�-�'� <br />fINAL INSPECTION Date <br />Approved as Cons�r�cled <br />everel[ PUBLIC WORKS DEPARTMENT <br />� 3200 Ced'ar Rlrnr;� <br />Everett, WA 98201 <br />Phane: 259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />W <br />F- <br />Y / <br />\— J <br />The undersigned owner/applicant hereby agrees to hold and save haim- <br />less the City ot Everell from any antl all claims for damages, costs, <br />expenses, or causes of action that may arise because ot installation <br />and maintenanr.e ot ihe improvement or other right-ol-way use hereto <br />applied lor and lurther agrees to remove same upon notice from the <br />City anrJ.tv-replace public p�y damaged thereby. <br />WQRJS/AUTHORIZED BY THIS PERMIT MUST BE STqRTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED F,ND THEREAFTER IS TO <br />BE DIL:GENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />