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� <br />� <br />r. <br />oaca�8 �/ <br />ADPlicetlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />VCK '3uzc, �=s� / 3�� i=, <br />PUEIic Worlu P��ml� • /� <br />BIOp.Dapt • <br />hellc Wod� FN A� �� <br />Tot�IHe = ��� <br />L�n �ppl F�� P�iO f <br />B�I�ncs Du� { <br />aiO �—O <br />Ysv,«r 992 �o <br />Zip <br />� <br />"S <br />Oeacribe Proposad Work �1 f% R►' i n c, c o i w�� i� r uiAc� i= S L'� � A-w�a S��R ►�%�/ C <br />Pro�ect Addresa pf known) <br />Attach four (4) copiee of plana (or proposed work • Draw to scale and note ihe following as applicable: <br />• Property Linea <br />• Outline and dimensions of ell existing and <br />propased structures on lhe lot <br />• Exietinp and propwed utilitlea <br />• Centerline of street <br />� Indicete North <br />• Show any proposed grading changes <br />• Show meesurements <br />PERMIT CONDITIONS <br />1. All calle for inepection shall be mede 24 hra in advance • phone 259•8815. <br />2. All work ahall be peAo�med in accordance with this parmit and current City of Everett Design and Construction <br />Stenderde end Specificationa <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />7� ��1' 7� /f�±�r'id/TT C.9/�c c�-� /�✓'/�v�E�4�✓�`C� <br />, 4J/Tf% �iL�%i'% �f1Y>//�?+,.S +/t9.�! C�'�„�,/,%%to/1� �%�""O, <br />4 <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everetl WA 98201 <br />Phone: 259•8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant he�eby agrees to hold and save harm- <br />less the City of Everett from any and all cialms for damagea costs. <br />expense& or causes of action that may erise because ot installalion <br />and meintenance of the improvement or olher right-of•way use hereto <br />applied for and lurther agrees to remove same upon notice irom the <br />City and to replace public property dameged thereby. <br />� �.� S� � �Py <br />Signature of p ant D te <br />WORK AUTH RIZED BY THIS PERMIT MUST BE STAFTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br />BE DIIIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 50 DAYS DURATION. <br />� <br />� <br />