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�ate � 9 Bfj <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />aueLc wo�ks Permit s <br />eiaa- oeo�- + _ <br />v�ei�c worb Fea s <br />Totnl fee <br />Lese �po�. Fee PsiE S <br />Babnca Due f �O C��� <br />/'i� � TJrrv.� ✓✓✓'�� <br />Ci�y Zip � Phone <br />• /' � ► � � � <br />�: — <br />�� .� • • � <br />Proiect Address (if known) <br />Attach tour (4) copies of plens for proposed work • Draw to scale and note the following as applica6le: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate NortYi <br />proposed structures on the lot • Show eny proposed grading changes <br />• Exisling and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor inspection shatl be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be peAormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specificatlons. <br />3. Call Location Underground Service 48 hrs, before you dig. TOLL FREE NUMBER 1•800•4245555. <br />7 APf �iGP�7lT Sf�9ll ,8.�' �PE'cp�i.e�.D T.P�i� (i�' TH�' <br />%?F.deF /F 7.1�E C/Ty NEEOS To Us.� Ty� fi�l/ <br />.S- A�i'LiGANT Syqt[ BE .e�Gtoi.e�'b Tc� L€T .V�'/GHBoR <br />To Ty� Sovr� usE <br />;y�y ��� �. <br />,y,9tj' of TN.E <br />C�:%���� �� 2/9�8 <br />qpproved lor Cons ction ate <br />�� <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUB�IC WORKS DEPARTMENT <br />� 3200 Ceder Street <br />Everett, WA 98201 <br />Phone: 259�8810 <br />ALLE` i{ <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />�J <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City of Everett irom any and all claims for damages, costs, <br />expenses, or causes of action that may arise because ol installation <br />and maintenance of the improvement or other right-of•way use hereto <br />applied lor and lurther a9rees to remove same upon notice Irom the <br />Cily and to replace public property demaged thereby. <br />�JtR/Yc.C/ ,e�nnW/IG�/1/� � - oL — D d' <br />Signa�ur� AppliCaM Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT �S ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />