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�. �'_`,� <br />Date� 5 <br />PUBLIC <br />Print ar Type Oniy <br />Lt�l� ► lP1' �l. <br />ow�e� <br />� <br />Appli�lion For <br />WO�iKS PEr�MIT <br />O <br />O <br />O p p p p <br />L O O O t! � II� O <br />� ��� d�� <br />bl W M [� W <br />I i��� _ i C�" 1�-i11? <br />O O O O <br />M � 11� t�li <br />MO L� O <br />��,N� <br />rer�s�oc���io��o� <br />1- H O � w ¢ <br />�a d� OJ] OG Watll� a3 <br />Pu�l¢ Wo�xs Permil s � �� <br />eieq Deo�.+ <br />Publ¢ WO�F9 F¢e <br />TOfal Feo S <br />Le5sAp0�FeePaiC S , _ _ . �jJT <br />8alance Uue <br />Phone <br />Applicant Mailin9 Adtlress CAy Zip Phor.e <br />Describe Proposed Work <br />Project Address (il known) _ a� S— <br />Attach luur (4) copies of plan, lor proposed work - Draw to scale and note ihe follov�ing as aGPticable: <br />• Propertl' LineS <br />� Ou.line and Cimensions of all existing and <br />proposed siructures on the lot <br />• Existing antl proposed utilities <br />• Centerline of street <br />• Indlcate North <br />• Show any propOsey grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calis fer inspedion shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pertormed in accordance with lhis permit and curren� City of Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. befoie you dig. TOLL FREE NUMBER 1-800•424•5555. <br />� �� <br />LY <br />�� y'(�a.�.FQ. /�/L�J'1. s CL/C � <br />� <br />� . /" � : � <br />ApriroJeA o o truction / Date <br />� �� �'- /j -�f-7 <br />F�_ INSPECTION Da e <br />Approved as Cons�ruCted <br />ev�ret� PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Evcrett, WA 96201 <br />Phonc:259�6810 <br />/2.-/-�Ej <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />_ / <br />� <br />O <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the Ctly ol Everett frem any and all claims for damages, co�ls. <br />expenses, or causes ot action that may arise 6ecause of installation <br />and maintenance of the improvemen� or olher righ��ol-way use hereto <br />applied lor and furiher agrees to remove same upon notice Irom the <br />Ciry and to reola.:e public proUerty darca9ed thereby. <br />we ol <br />Ii�J��If� <br />� <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DIL!GENTU'' PURSUED TO COM1IPLETION. THI° PERMIT MAV BE <br />CANCELLED BY THE GTY UPON ANY STOPPAGE OF WOHK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />