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. <br />�ate 3 /� <br />ApDlir�fion For <br />PUBLIr WORKS PERMIT <br />Print or Typs Only <br />������ � <br />Owner <br />���'1�I C' <br />Applicant <br />Describe Pro ose�� W2 . <br />rT <br />Project Address (if known) <br />_, � <br />J <br />Mailing Address <br />PUEiic Worke Perm�t • �� _ Z� <br />B�Ep. Depl. • <br />PuElic WorMs Fee s <br />Tolel Fee <br />Lefs Appl Fee Pei� S <br />s 2� �d <br />Belente Oue <br />Glp <br />uJ/ .�T.4-r N ► nl� <br />Attach four (4) coFies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate Norih <br />proposed structures onthelot • Show any proposed grading changes <br />� Existing and proposed utilities � • Show measurements <br />:s8 4� �5 <br />Phone <br />t � <br />Phone <br />, TO Ti�/� <br />PERMIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs in advance • phone 259-8815. <br />2. Atl work shell 6e performed in accordance with this permit and current City of Everett Desig� and Const�uction <br />Standards and Specifications <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424�5555. <br />� �i�i2'/CifNT Tp C�/YGG �.e Z•tE�ECTOi✓ /F <br />cS'E��'�' d•f' Wi9iF� SE".P!/.cf �.eF To 6�' <br />�`'EGo C'i97z`'� O,� f,�"�in.r/Gc�'O . <br />� �a.�-�y �E.e c'irj/ Sr�•�o..�.e0 ''�.92 f� <br />�.�o�� ��0 86 <br />Approved lur iruction Date <br />� �'ei��— �� d'L <br />INAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett. WA 98201 <br />Phone:259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett trom any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenence of the improvement or other right-of�wey use hereto <br />applied for and turther ag;ees to remove same upon notice from the <br />City and to replace puhlic property damaged thereby. <br />, <br />Signature of Applicant Dale <br />WORK AUTHORIZED BY TH�S PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEflEAFTER �S TO <br />BE DILIGENTLY PURSUEO 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 />