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�<r`� ��� APPiication For <br />PUBL"C WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everelt, WA 98201 (425) 257-8810 <br />TYPE OR PRINT GivLY <br />Owner <br />Describe Proposed Work <br />PROJECT NDDRESS (if known) <br />Mailing Atldress Ciry <br />'� E✓ � <br />Mailing ddress City <br />Date �r i-� �,9 <br />Public Works Permit q ���� <br />Building Permi� k <br />Public Works Fee 5 %�" I <br />Zip Phone <br />�;, - <br />Phone <br />Anach lour (4) copies plans for proposed work - Draw to s. ale and note ihe lollowing if applicable: <br />• Propetly Lines • Outline and tlimensions ol all existii ig and proposed stmctures on the bt • Eaisling antl proposed utitities <br />• Centedine of street • Indicato NOAh • Show any proposed grading changes • Show measuremeNs <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be per(ormed in accordance with this permil and current City of Everett Design and <br />ConsVuction Standards and S�ecitications. . <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />�'. 1�f��PtrV1 LiWtii'I,eC "G� ��� in �jtf�G•�v%r(i�� Z✓"G4 —'ih� bG <br />�� I <br />h�^ v� � f <br />�. ��� � � � � � <br />�e, ��'� � m l� i m�•n o-� 12 l�t�k �r� <br />���n�n� .� leX,y„�-�a„ k,�e. <br />o� S E c�v- n� o��,-�� . <br />W <br />� <br />� <br />V / <br />Z <br />0 <br />� <br />V / <br />O <br />a, <br />- rr��� �Gvlc� �zh r�d �.c�'c� ra-�ade.,�-c�-, <br />�y. �-�'ICe L;M�-Er�czd �r= n'le-�. hf, - <br />- -�m' �C�e� � <br />�{.e ,�r�s-f re�G,� �a r�,� <br />7�� � <br />✓ <br />�7,� n-+a/ <br />ACKNOWLEDGEMENT OF CONDITInNS <br />/ ���� The undersigned ownerlapplicant hereby agrees to hold and save harmless <br />tho City ol Everett from any and all claims lor damages, costs, expenses, or <br />pp ve or s ct y�e causes ol action that may anse because of installafion and maiNenance ol the <br />improvement or other righl-ol-way use hereto applied lor and lunher ngrecs to <br />� //—_ � c,,- remo e s e u n notico fro the City and to replace public property dam- <br />�� j� �c. � — �� �� � / age reby. � <br />FINALINSPECTION Date � � �,r <br />Approved as Cons�ructed '` ' � <br />ig atur� o pp�ca ate <br />WORK AUTHORIZED BY THIS PERMR MUST BE STAHTED WfT}iIN 180 DAYS OF DATE PERMIT IS ISSUED M1D THEREAFZER IS TO BE DILIGENRY PURSUED TO <br />COMPLEfKKJ. THIS PERMfT MAY BE CANCELIFD BYTHE CITY UPON ANY STOPPAGE OF WORK ON THiS PRQIECTOVER 90 DAYS WRATICN. <br />