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� <br />� <br />TYPE OR PRINT ONLY <br />�� <br />Applicant <br />Application For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everett, WA 98201 259-8810 <br />EL FU« ,s7,z <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />Mailing <br />o �Gg„i A v <br />�,�-�r �'- �? c__"�,-� ,4 ✓ <br />Atlech four (4) copies of plans for proposed work - Draw to scale and note the tollowing if applicable: <br />�� � <br />DatP • <br />Public Works Permit # V(LV <br />Building Permit q <br />Public Works Fee $ Y� ���_ _ <br />�.s5�+ n� /F'.'1I <br />Phone <br />•Property Lines 'Outline and dimensions of all existing and proposed structuros on ihe lot •Existing and proposed utilities <br />•Centerline o1 street 9ndicete Norih 5how any proposed grading changes •Show measuremenis <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. ' <br />2. All work shall be performed in accordance with this permit and cunent City of Everett Design and <br />Construction Standards and Specifications. UB-�1-97 1:14PM <br />3. Call Location.Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-86D21Y4-5555. <br />�� �""/���" �}�r��aK OTHER 43.50 <br />'-j � llPeO Gj 77w ,S'�yicc%�j C�e�i� I C �OTAL 43.50 CHEK <br />! -/ <br />G �,1�-�,IN.eA. <br />✓�, �rcv;� P•ras� oN ��� l� <br />�r s d,',-uf�� � �e%c <br />u/ar k.r ,1-r s��c �v r <br />l� <br />a <br />� <br />��G' � <br />Date <br />�i✓�l'-� "� <br />i <br />/G^l•S / <br />FINAL INSPECTION Date <br />Approved as Constructed <br />OF1637 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save hartnless <br />the City of Everett from any and all claims tor damages, costs, ezpenses, or <br />causes of action that may arise because of installation and maintenance of <br />the improvement or other right-�t-way use hereto applied forand furthar agiees <br />to remove same upon notice from the City and to replace public property <br />damag€d ereby. <br />� / ' `��=✓I ��/� / i � j /% 7 <br />� <br />1 ignature of Ap?licant Dat <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERt.11T IS ISSUED ANP THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />COMPLETION. TNIS PERMIT MAY BF C.4NCElLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAVS DURA770N. <br />