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•• <br />� . > 1 ��� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Address <br />Oescnbe Proposed Work ��Ol I� S-1'1� _ <br />Prolect Address (if known) <br />ity <br />Cil�;/ ZIp <br />Attach lour (4) copies of plans lor proposed work - Draw to scale and note the lollowing as applicable: <br />• Propert/ Lines <br />• Oulline and dimensions ol all existing and <br />proposed structures on the lot <br />• Exisiing and proposed utilities <br />Pun.�c \:mws Pe,mQn y _���' <br />eia9 Doo� • �i <br />PuUla Wo�k9 Feo <br />TO�Tlfee 'S . <br />LesSRpplfecCa�g � <br />Be'a�m Oue S �- <br />• Cenlerline ol strer,t <br />• Indicate North <br />• Show any proposed gradi�•g changes <br />• Show measurements <br />LINE <br />ILr•]ttq <br />PERMIT CONDITIONS <br />1. All caNs for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work sheU be peAormed in accordance with this permit and current Ciry ol Everett Design and Construdion <br />Standards and Specitications. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NI�MBER 1-800-424•5555. <br />5� <br />/T Lod,�s aa, � � ,f1�r.�-� �� � <br />.-� !'�.� i?cr,�,� � �.�t i/%o -t,� ��e�, <br />�(�/?z�eT� /n-' �u� S.D�e.� ���o-�' a. 3 �'_/ <br />d.��. ���� � �o,�� �.� .�-�- ��� <br />.,�;,�, ,�� ��,�-� .�,zf , <br />� • ,y^ <br />cJ (1/ L �� <br />ApProved lor Con Iructio ate <br />�� =' � 'L <br />FINAL INSPECTION Date <br />Approvetl as Consiructed <br />evcrcll PUBLIC WORKS DEPARIMENT <br />� 3200 Cedar Slrcet <br />EverelL WA 48201 <br />Phonc: 259�8810 <br />ACKNOWLEDGFAIE�IT OF CO�.CITIONS <br />The unde�si9ned owner/apphca �1 h�rr.by agree5 to nold and savc harm� <br />less Ihe Cdy ul Eveietl Irom any and alt claims fo• damages, costs <br />eupenses, or causes ol action ihat may anse because ol mstallation <br />and maintenance of ihe improvement or other nght�obway use herelo <br />npplied 1or and luriher agrees to remove same upon notice Irom ihe <br />'T,ty and to replace public properly dama9ed Ihereby. <br />�ORK�AUTHORIZ[D BY �FffS�ERAd�T�A1UST BE STARTED \NITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED PND THEREAFTER IS TO <br />BE DILIGEIJTLY PUHSUFD TO COMPLETIVN. THIS PERMIT A1�Y E3E <br />CANCELLED BY THE CITY UPON ANY STOPPAUE OF WORK ON THIS <br />FROJECi OVER 90 DAVS DURATION. <br />