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r <br />� <br />Date �' �-$ �� <br />Application For <br />PUBLIC W()RKS PERMIT <br />Public Woiks Permlt ♦ � � � <br />a�d9 oao, , �3��a � � 9 <br />Puolicworbfce $ /vO —� —' <br />Totel fee <br />� <br />Lesa App: Fee Pa1C $ <br />Balanca Uue $�� U• 7 7 <br />f=rint or Type Only <br />�co..n.s' I�as�„ <br />r,nc�rCw �-,�ll U1-Ui Tuc%.�.t1%3[�J'� Ev�'.rc/i Lv.1 �f1i�3 ��%'Ub'(ntj <br />Owner Mailing Address City Zip Phone <br />5�a�� <br />Applicant Mailing Address City Zip Phone <br />DescribeProposedWork �N�^•��+� ��x�s'Ei�� �""••�� "^'�' o��c� h�ci <br />Project Address (if known) <br />�1v � <br />Attach lour (4) copiec of plans lor proposed work - Draw lo scale ar,d note lhe following as applicable: <br />• Pronerry Lines <br />• Outlino and dimensions ol all existing and <br />proposed structures on the lot <br />c Existing and proposed u�ilities <br />O Cen�edine ol street <br />11 Indicate North <br />�� Show any proposed grading changes <br />• Shuw measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this Fermit ane current City �f Everett Design anc Construction <br />Standards and Specilications. <br />3. Call Location linderground Service 48 hrs. belore you dig. TOI.L FREE NUMBER 1•800•424•55$5. <br />� '- <br />, s,�l� w��k �....�' �-1,��-� ,.....� N.:�...�._� � ���.�;„ �� <br />��,c: ��,z�� ��- ► ��.v��� 2_Z3-s�r <br />5. Cd S z �� ec�,, e...�..;1- o... l•� �{— <br />�� V�t'w �'.wP.•�P.v <br />� C ,�.. ; �b�. � �,�.,: k�> <br />�'��./��� a•a3-y� <br />Approved lor Construction Date <br />� %,/ ' "� .ri: ! �--- 7 -a2 r- �y <br />FINAL INSPECTION ate <br />P.pproved as ConsVucted <br />everett PUB'_IC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everett, WA 98207 <br />Phone: 259-8815 <br />,�. �i� bz Sct..._, - �,�� � r,,,. <br />L�t��_iL tii\ ��..; L1\�f'l'�-"(O.'� <br />__ 1_ Yl ifJ t' . ��r <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />�w <br />_ / <br />Z <br />� <br />�F/�y <br />V♦ <br />0 <br />� <br />The undersigned owner/applicaN hereby agrees to hold and save hann- <br />less the Ci�y of Everelt trom any and all claims for damages, costs, <br />ezpenses, or causes of action that may arise because of installation <br />and maintenance of �he improvement or other righl-ot�way use hereto <br />applied for and further agrees to remove same upon no�ice from the <br />City and lo replace public property damaged thereby. <br />�T-% � z z 3 �g' <br />Sig a�ur of Applicant Date <br />W UThiORIZED BY T S PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUCD AND THEREAFTEF IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MA'Y BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF INORK ON THIS <br />PROJECT OVER 90 DAYS DURATIOIV. <br />