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Dat /-.F4;-V <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Wawa Pcrmit •• O/_ 7 T <br />Bldg. Dent. • <br />P,buc W F..Fad <br />Total Fee S <br />Les. art Fee Paid $ _� <br />Balance Due S 7C OC <br />r <br />Owner ��,.......«.�,r <br />Mailing Adtlress City <"'D Phone <br />Applicant Mailing Address City LP Phone <br />Describe Proposed Work �-. �>ti,.r�cY7/ J r�a..�._✓ /J <br />Lu <br />Project Address (if known; G,LI,e mar. ,ed <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Putline Lines • Centerline of street <br />O Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grzding changes <br />• Existing and proposed utilities <br />• Show measurements <br />DO NOT WRITE <br />BELOW THIS LINE <br />PERMIT CONDITIONS <br />O <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259-5815. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />-, Iif/ST,A.G !],��.d„ly �/PE fico�rlG ESEmE�rJT <br />AS .Pcgl�it�E1> y �S'Hoei ,aGer <br />/�i <br />J �,evd�OE G,�oSsr' ;'sc c: ianJ !JE'i d is of T.eE,rl cf/ <br />1___v <br />�' 1��2,9i,✓ Pi.JE Tn dE' LNS:viGE'1J fi'co�✓lr EdsEinE',t,yi: <br />i' <br />/u,GIJ, R/,`%Cs� �PE /S TO dE' Ti�,vr-Liti'EO %D %0a&,1, C <br />C` D.�v' field GE Sfi6'Tea�!> <br />c�, t7,z: dc� GcJi4}/ Tv Z7/mod✓Eo GcJ/9s:� /.�tT ��vM <br />ST.�I-�j P,di�iN.% <br />%f/E io Ti/E A/�,�Gi�ejuTS- �,PC��E.ciy LitJE <br />ACKNO" LEDGEMENT OF CONOITIJNS <br />Approved for Coltslru Chon , //!J/ Date <br />a%— <br />FINAL�RTSPECTION Date <br />Approved as Constructed NOTE: TO Ft LC = 001L11 NA <br />put3uc. wo¢ttG <br />everett PUBLIC WORKS DEPARTMENT Fo2ht tT wA,5 Lpn- <br />Ever. Cedar Street <br />Everett, WA 98201 <br />Phone: 259.8815 ftVL <br />The undersigned ownerfapplicant hereby agrees to hold and save harm. <br />less the City of Everett !Tom any and all claims for damages. costs. <br />expenses, or causes D1 action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and furthe agrees ! ,remove same upon n�ice, f ITI Ahe <br />City and to replace pubfie prop rty amaged thereby.77, Qq& <br />Signature of Applicant / -Date <br />WORK AUTHORIZED BY T(iIS PERM T UST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISS AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />