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Date 7 �� % <br />Applica�ion For <br />PUBLIC WORKS PERMIT <br />Print or Type Oniy <br />� <br />' Owner <br />/1 <br />Applicant <br />Describe Proposed Work <br />Project Address (if known) <br />ng <br />/i <br />Mailing Address <br />Pu�lip Wo�ks Permit • ��~?� / <br />BICB. Deo��' <br />Puolic Works Fee <br />Totel Fea S <br />Lexa ApPI Fee Pa10 S <br />OC� <br />BaianceDue S ?n—� <br />.k N c✓ �n � ci i .�c � j.� <br />2ip Phone <br />i / �' � � <br />Zip Phone <br />Atlach lour (4) copies ol plens br proposed work • Draw to scale and note the lollowing as applicable: <br />� Property lines • Centerline ol street <br />• Outline and dimensions of all exisling and • Indicate �'orth <br />proposed structures on the loi • Show any proposed grading changes <br />• Existing and proposed utilities � Show measuremenls <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall b=. perlormed in accordanc� with thi^, permit and current City of Everett Design and ConsVuction <br />Standards and Specilir.ations. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•S00•424•5555. <br />G'�C%/'_.0 %O L�F- ��>�i.�i_: f-En' ��/-'r'f,t"'i.��/_J �.c%�NYiii.�c;— <br />/�j��p %—ZO - 97 <br />%/�i� :-c�;�,t?C /,�FC'rUi.�'cS ��' :.$�c�tJc�i'. r!c �E ; �'T.a�'v� <br />/`�E.c'/��/% �'C.'�:� %h/E !�c';.�i>,�'c.- l�E�,T <br />i � <br />/ � <br />'/� �dt: G'�z '.1!' � % <br />Ap�roved lor Con on Date <br />� �--- /� -i�f f7 <br />FIN.4L INSPECTION ate <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everett, WA 98201 <br />Phone:259�8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />z <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less Ihe City of Ev^rett f�om any and all claims for dainages, costs, <br />expenses, or causes uf action that mal' arise because of installation <br />and maintenance ot the improvement or other righFOFway use hereto <br />applied lor and turther agrees to remove same upon notice Irom the <br />City and to replace public property damaged thereby. <br />k( �lra.f�, d �c,�1'.=w_ <br />Signature of Applicant �' � Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS Of DATE PERMIT IS ISSUED AND THEREAFTEP !S TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY TNE CI7Y UPON ANY STOPPAGE OF WORK OK THIS <br />PROJEC( OVER 90 7AYS DURATION. <br />