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Date� � <br />Application For <br />PUBLIC 'WORKS <br />Print or Type Only <br />Alailing <br />Describe Proposed Work <br />Proiect Address (if knownl <br />� <br />x <br />� <br />u� <br />ro <br />F�RMIT <br />¢ <br />0 <br />O <br />¢ o0 <br />N O O <br />� W w <br />City Z�p <br />Attach iour (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all exisling and <br />proposed s�ructures on Ihe lot <br />• cxistmg and p�oposed utilities <br />Pub�¢ Wo�Ms Permil a v v <br />91e9 DeVI.+ <br />Puoec worMs Fce <br />TomiFee 5 <br />Less AOP�� Fec PaiC u <br />aa���« o�� s 2a—�-- <br />/yp.9�aqo <br />• Centerline of street <br />• Indicate Norlh <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />7. All calls for inspection shall be made 24 hrs. in advance - phone 259-881 O. <br />2. All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specificalions. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-$00•d24•5555. <br />? /l,C�sA'+�dZl�ei /L'� � �.�etiu''�L✓ CO�/�+����.Q,e�-c��Qy .4r�6' /1�./C�O.CZ�ei <br />�:tJLGiL C✓/butLCv2yJ �iL Src�,+�aR/t� ' JO %. B�-�+� �t <br />�i/.t.r�' L� k G.'-t'-y'� l/(Yl1.��ui� m�' �ia�2fcy �j �itcJ L�.�G� � <br />s <br />� . i <br />' .�CJOS�✓ �T�Z %/t�8 <br />Approved lor Constru ion � Date <br />��� �./`=�../�� eJ.Ji..� <br />. FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259-8810 <br />ne <br />ACKNOWLEDGEMENT OF CONDITIONS <br />osBs <br />W <br />� <br />� <br />/i� <br />V♦ <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less ihe Cily of Everet� Irom any and all claims for dzmages, costs. <br />expenses, or causes of action ihat may arise because ol installation <br />and maintenance ol �he improvement or o�her right�ol-way use hereio <br />applied lor and lurther agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature ol Applicant � �te <br />WORK AUTHORIZ[D BY THIS PERMIT MUST BE ST.iRTEU WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br />CA�JCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />