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Date�� g <br />Application For <br />PUBLIC �;;/C1RKS PERMIT' <br />Print or Type Only <br />Mailing <br />ciry <br />� <br />� ��c Works Pcrmq ca c <br />�..19. Deol. s /J�7J p <br />Pu�lit Works Feo <br />Totai Fee s <br />Less AOPI. Fee PaiC $ <br />Baianceoue $ <br />�� �iSS- <br />Zip p <br />�,.a�u �S �S <br />Describe Proposed Work �� K 3�L1 (� %1�n C� _ <br />- ,J T <br />Project Adtlress (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the lollowing as applicablr.: <br />• Property Lines <br />• Outline and dimensions of all exisling and <br />proposeA structures on the lot <br />• Existing and proposed utilities <br />• Cenlerline ot sireet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measuremen�s <br />PERMIT CONDITIONS <br />1. All calls for inspection shall 6e made 24 hrs. in advance • phone 259-8810. <br />2. All work shall be performed in accordance wlih this permit and current City of Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />/`�G/i��l �C Gr%7,P,�- <br />������T �c%% �('isr�ri!i��� <br />� -ai 8s <br />�� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />�LJ <br />� <br />� <br />0 <br />a <br />The undersigned owneUapplicant hereby agrees to hold and save harm- <br />— less the City ol Everett irom any and all claims lor damages, costs, <br />ezpenses, or causes ol action iha� r�ay arise becaus� of instTllation <br />and maintenance ot the improvement or other right-of-way use hereto <br />Approved for Construction Date applied lor and further agrees to remove same upon notice from the <br />Ci' and to replace public properry damaged thereby. <br />FINAL INSPECTION Date <br />Approved as Constructed SignaWre ot Applicant Date <br />everet[ PUBLICWORKSDEPARTMENT WORK AUTHORIZ[D BY THIS PERMIT MUST BE STARTED �VITHIN <br />� 3200CedarStreet 180 DAYS OF OATE PERtdIT IS ISSUED AND THEREAFTER IS TO <br />Everell, WA9B201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />Phone: 259�BB70 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PqOJECT OVFR 90 DAYS DURATION. <br />