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Date��3 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Address <br />Address <br />Describe Proposed Work �V�� «• �_ `k^+-�L� <br />Project Address (if known) <br />i'�plic Works Pormil � �� � _ <br />eioa� oeP�. • _ <br />Puelic wo�ks Fue � �) , Q� <br />Totel Fea <br />. ,.. ,�r �. Li',_... <br />�� . loas Ap0� Fee PaiG S <br />`� ' ��' C�" ' ��, Ba�enceDue. S ��' �� <br />�i y <br />, , ; ,...,. <br />613 <br />���:' � .., , <br />i__�__� �`,r; � o �I :3�rs -G: 2 a 9 <br />y�.�� �,� ��u �t�Zlp I�,�, �'�., i Phone <br />� � . ! � . � `' � - � <br />a �-I 3S <br />Aqach four(4) copfes of plans for proposed work- Draw to scale and note the following as applicatle: <br />• Property Lines • Centerline of street <br />• Outline and dimensions ot all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing und proposed utilities • Show measuremenis <br />PERMIT CONDITIONS <br />Phone <br />1. All calls for inspectlon shall be mede 24 hrs in advance - phone 259•881 5. <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specificationa <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•S00•424-5555. <br />�..��'�� %�-�—�3 <br />�pproved for Construction Date <br />1-�T�!e�.�_ 3-/3_y� l <br />AL INSPEC:TION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 9b201 <br />Phone: 259-8815 <br />FCKNOWLEDGE.<eNT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />�ess the Ciry ef Everelt trom any and all claims lor damages, costa <br />ezpenses, or causes o1 action that may arise because ol installation <br />and maintenance of the improvement or other righPohway use hereto <br />�pp11�3�and lurther agrees to remove same upon notice from the <br />City �W'to�eplace public property da�naged thereby. <br />WOAK AUTHORI2Ef1 BY THIS PERAIIT MUST BE RTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AN HEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETI . THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY ST PPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />