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✓ <br />oe►e Z � � R@ <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />���� <br />� qa o�/A'kff �(isr �vt R k <br />Mailing Address City <br />Mailing Address Citv <br />Describe Proposed Work W A N7" T d I/ s� I T F D R fr,q �' p�N <br />Project Atldress (it known) <br />Zip <br />PUDIie Worki Perm�il • <br />eiao. oso� . _ <br />PuElic Works Fee <br />Tolel Fea S <br />Lesa Appl. Fee PeiE $ <br />Balence Uue f � ��.QFrE' <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline ol street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utili�ies • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be mede 24 hrs. in advance • phone 259-8810. <br />2. All work shall be perlormed in accordance with this permit and current City of Everett Design and Constructlon <br />Standards and Specitications. <br />�. Call Location Underground Service 48 hrs before you dig. TOLL FREE NUMBER 1-$00-4Q4•5555. <br />/. %%P�LiCANT d'/f9CL �E �P�c9U�.eF�O <br />f�ti��' /F TyE �iTy N,�'os ro <br />To ,e�ihov� 7-��. <br />�s�- TiYF 9«�y, <br />� r�'r'i �' 9.�r� ,Sy9cc 8� �� ai,e�'� �o L�'T it/�iU.S�.so� <br />To Ty�' Sour� 4S€ f/9cF oF Ti/E /lCL,Ef/ /F <br />�y�f/ u/971/r' Ta . <br />, <br />��ioa�� ��9�,� <br />Approved lor Ca struchon Date <br />N/ <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everet4 WA 98201 <br />Phone: 259-BB10 <br />-�� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />The undersigned owner/applicant hereby agrees to hold and cave ha.m- <br />less the City ol Everett irom any and all claims for damages, costs. <br />eapenses, or causes of action that may arise because of installntion <br />and maintenance of the improvement or other right•ol•way use hereto <br />applied lor and further agrees to remove same upon notice Irom the <br />City and to repiace public property damaged thereby. <br />� �� y� �y � <br />SignaWreolA hcant Date <br />WORK AUTHOqIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTcR IS TO <br />BE DILIGENT�Y PURSUED TO COMPLETION. THIS PERMIT MAV BF <br />CANCELLEU BY THE CI7�Y UPON ANY STOPPAGF. OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />