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Date <br />—�—cor^'-. .r.-�+�.f"-- ... -v-9'--"--.:^'�'ry,w—t.c+� . ... <br />. . . . ��...-s.��..i. , 'e .. -.. . <br />Applicetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Applfcant <br />Deecribe Proposed <br />Pro�ect Address (if known) <br />3/ni. <br />I t/ 7-� <br />Meiling Address <br />,� <br />I• <br />�1 <br />PUEIic WorMs Permil � _ � "' ��`� <br />eiao. oec�. • � <br />fuel¢ Wo�ke Fee <br />Tatei Fae S <br />Less ApO� Fee P�iE s-/T� <br />Balance Due � C�.7/ <br />�- <br />AtteCh four (4) copies oi plans (or proposed work • Draw to scale and note the follnwing es applicable; <br />• Proparty Lines • Centerline ot street <br />• Outline and dimenslons of ell ezisting end • Indicate North <br />proDosed structures an ihe lot • Show any proposed grading changes <br />• Ezieting and propoaed utilitiea • Show measurements <br />PERMIT CONDITIONS <br />1. All cdl6 for Inspection ahall be made 24 hrs. in advence • phone 259-8810. <br />2. All work ehsll be pertormed In accordence with lhia permit and current City of Everett Deslgn and Conatruction <br />Standerdt end Speciflcetiona. <br />3. Call Locetbn Underpround 3ervice 48 hra befcre you dig. TOLL FREE NUMBER 1•800�424-5655. <br />'r' �� %�/ �,.od ;� /2 S (/� ,�l 8' Z `� ' b£� <br />� f� /7 <br />� <br />A ov o �ruction . Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phone:259•8810 <br />�< y- Y7�� <br />�?6 -39os� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />F- <br />� <br />The undersignetl owner/applicant hereby agrees to hold and save harm• <br />less the City of Everett from any and all claims for dameges, costs, <br />expenses, or causes of action Ihat mey arise because of installation <br />��and maintenance of the improvement or other right-o4way use hereto <br />applied for and lurther agrees to �emove same upon iotice irom the <br />City and to replace public property damaged thereby. <br />i/��i// � �L/z i:G-. �� �f7/r�X <br />Signature of Applicant � Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED 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 />