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Date� � r' <br />Application For <br />PUBLlC WORKS PER�VIiT <br />Print or Type Only <br />Owner <br />Nanress <br />Descrite Proposed Work _-rLl�'�A-LL" -___._ <br />y <br />Project Address (if known) <br />r" <br />Zip <br />Pu01ic Works Permit c / ' ' "'— <br />31Cg. Oepl. + ,� <br />PUDIic Works Fee <br />Tolal Fee Pu <br />L¢95 Ap01. Fee Paip � <br />drlenca Due S <br />Attaci� four (4) copi=s of plans for proposetl work � Draw w scale and note the iollowing as applicable� <br />A Property Lines • Centedine o� s�reet <br />! Outline and di.ne�c�r ;� u( ;.!! nxi�ting and • Indicate North <br />Froposed sfr�ctures on ihe lot • Show any proposed grading �hanges <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />Phone <br />t. All calls for inspection shall be made 24 hrs. in advarce • phone 259-8815. <br />2. All work shall he perlormed in accord2nce with ihis permit ard current City of Everett Design and Constructicn <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you diq. TOLL FREE NUMBER 1-800•42�':•5555. <br />J <br />/ //5'GiG /�/v���- fE'ni.�i�- it/c�7 �-¢'� J <br />Appro✓ed lor Co islruclwn Date <br />FINAL INSPECTION Date <br />Approvetl as Conshucted <br />everett PUBUC WORKS DEPARI'MENT <br />� 3200 Cedar Street <br />Everett, WA g9207 <br />Phone:259-8855 <br />��- / <br />� GzG.� <br />. <br />.�� ��97 <br />ACKNOWLEDGEM[NT OF COMDITIONS <br />Tho undersigned owner/applicant hereby agrees to hold znd save harm� <br />less the City o! Everett irom a�y and all claims lor damages, costs, <br />expenses, or causes ol acti�n that may arise because of installation <br />ana maintenancf: ot ine improvement ur other right-ol-way use hereto <br />applied for and luriher sgrees to remeve same upon notioe from the <br />City and to replar,e public roperty dar.iaged thereby. <br />�IJV"' � � l� �'l <br />Signa re of Appiicant Date <br />WOF� AUTHORIZED HIS PERMIT G1UST BE S ART D WITHIN <br />780wAYS OF GATE RMIT IS ISSUED ANf� THEREA TER IS TG <br />BE DILIGENT�Y PURSUED TO COMPLE7IUN. �HIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY £TOPP4GE OF WORK ON THIS <br />PRCJEC70VCP. 90 DAYS DLIRATION. <br />