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TYP�E OR PRINT ONLY <br />Appiication Par <br />PUBLIC WORKS PERMIT <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar $treet <br />Lverett, WA 98201 259-8810 <br />�1 Z_o <br />Mailing Address <br />Date��/q� _ � <br />Public Works Permit # _1 ���J 8 <br />Building Permit p �� <br />Oj <br />Public Works Fee $ 2Q <br />. B/� <br />City Zip <br />l , ' , /t7 g � <br />City Zip <br />� • O <br />�O� <br />�,�� � D,�, <br />' ,���,. _ <br />Attach four (4) copies of plans lor proposed work - Draw to scale and note the following if applicable: �Q�G -fJ"� <br />•Property Lines •Outtine and dimensions of all existing and proposed struUures on ihe lot •Existirig and prop <br />•Centedine of sireet •Indicate Norih •Show any proposed gratling changes 'Show measuremenis <br />PERMIT CONDITIONS: <br />utilities <br />�� <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. Ail work shall be performed in accordance with this permit and current City of Everett Design and <br />Gonstruction Standards and Specifications. <br />3. Call Location Underground Service 4R hrs. before you d?g. TOLL FREE NUMBER 1-800-424-5555. <br />.%l Y.r � ��� Z /1��k <br />Approved for P.� struction Oa � <br />� � � =� g i� <br />FINAL INSPECTION Date <br />Approved as Consiructed <br />S7�S <br />,�,.gf. _,,_-=.0 =:�n�t'>: <br />� <br />°�r,Q9bJ'� <br />7TNc" 3�Q.�)� <br />='hSi: "�,^,^;J <br />AI;KNOWLEOGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees tc hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of installation and maintenance o( <br />the improvement or other right-of-way use hereto applied for and further agrees <br />to remoe�e same upon noLce from ihe City and to replace public property <br />damageC thereby. <br />! � � t� _ �i� ' ..2 -az <br />/ ` � <br />Signature of Appliwnt / Date <br />WORK AUTHORIZED BY THIS PEflM1T MUST BE STARTED WITHIN 180 DAYS Of DATE PERMIT IS ISSUED ANDTHEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />COMPiEfIOtJ. THIS PERMIT MAY BE CANCELLED BV i HE CIN UPON ANY S70PP4CE OF W�7RK ON THIS PROJECT OVFR 90 DAYS DURATION. <br />