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Date�l� <br />Applica�ion For <br />PUBLIC WORKS PERMIT <br />i+rint or Type Only <br />aNner <br />Mailing <br />tK <br />�9-/sc� �� <br />Pu04c Woas Vo�m�l • /yy <br />61�g �e0t' � Z,,.�,y(/_6-- <br />PubhcWc�hsFco s <br />Totrl Fee <br />LessAno� FeePaiO S <br />�— _ <br />e.,i���� o�o s 2G�_� <br />! J1J�—��I/N-/Nuti yX/'�36 7? 5=a�13 3 <br />City T Zip Phone <br />Describe Proposed Work _�P ����-r--a=L� a ���j��! �'V �� � �'��--- <br />Prolect Address lil known) / la G L� — riir r i .ci.c <br />Attach four 14) copies of plans for proposed work - Draw to scale and note Ihe lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed Siruc�Ufes on the lot <br />• Ex�sting and proposed u�ilities <br />� Centeriine of street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measure.nents <br />PERMIT CONDITIONS <br />��. All ca�ls for inspection shall be made 24 hrs. in advance - phone 259-8810. <br />2. All v.ork snall be Derformed in accordance wilh this permit and current City of Everett Design and Construction <br />Stancards end Specitications. <br />?. Call Locatiun Underground Service 48 hrs. 6efore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />ti��9 � � > � ��� <br />!,' Z- _. ��-�y � `� <br />Approved lor Co�ction ate <br />�' <br />FINAL INS E O Dale <br />Approvetl as Constructed <br />everett PUBUC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl. WA 98201 <br />Phone: 259�8010 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less tlie City ol Everett Irom any and all claims lor tlamages. cos�s. <br />expenses, or causes ot action that may arise because of installation <br />and maintenance of �he improvemenl or other right-o4way use hereto <br />a d lor and luriher agrees to remove same upon notice Irom the <br />iry an replace qy611c property dafna�ed thereby. <br />WORK AUTHORI2ED BY THIS PERMIT NUST BE STAFiTED WIT41N <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO.IECT OVER 90 DAYS DURATION. <br />