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��5 <br />H <br />9y� <br />H�� <br />K n <br />��� <br />� O � <br />ON <br />Og <br />Q�A <br />t"y� <br />►-� H <br />8� <br />n�y <br />�O� <br />Date� <br />•��i <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Applicant <br />Mailing Addres;: <br />c,ry <br />Oescri6e Proposed Work rT'tr/AdG iiTn IA �g� • P�cii7,Ae hnvN $ <br />Pwjecl Address lit known) <br />Pu�bc 1VarAs Permil • <br />Bi�B �e0� a ��Z <br />PUUhc worb Fee <br />Tolaliea S <br />Less Rool iee PaiC � <br />Balance Due $ <br />Phone <br />ZiP Phone <br />Atlach four 14) copies ol plans lor proposed work � Draw to scalr. and note Ihe lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />prOpoSed SIrUCtureS On ihC IOI <br />• Ezisting and proposed utilities <br />• Centerline ol streel <br />• Indicate North <br />• Show any proposed gratling changes <br />• Show measur�ments <br />PERMIT CONDIT�ONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 2b9•5810. <br />2. All work shell be performed in accordance with ihis permit and current City ol Everell Design and Conslruction <br />Stantlards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />����e` w�z�-Y�fJ�..n,�-r� /I�����.�-v�-� <br />Appwved lor Construction Dale <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259�8870 <br />Date <br />c�U,,� e�?��ol'=fl-- <br />R. -i¢ - �/ <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Z <br />O <br />`�A <br />V+ <br />O <br />a <br />The undcrsigned owner/applicant hereby agrees fo hold and save haim� <br />less the Cily ol Everett Irom any and all claims foi damages, costs. <br />expense5. or Causes OI ac�ion Ihal may ari5e Uecause Of inSlalla�ion <br />and maintenance ol Ihe improvemenl or other right-ol-way use hereto <br />applied lor and furlher a9rees to remove samu upon notice Irom the <br />Cily and to replace public property domaged Ihereby. <br />Signature of AppGcant Date i <br />WORK AUTHORIZED BV THIS PERMI7 MUST BE STARTED WITHIN <br />160 DAYS OF DATE PERMIT IS ISSUED AND THEREAFT[R IS TO � <br />B[ DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE I, <br />CANCELLED BV THE GTY UPON ANY STOPPAGE OF WORK ON THIS � <br />PROJECT OVER 90 UAYS DUfiATION. <br />