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Dat 3� �' <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Puplic Wu�hs Permli s �/ � ��O <br />eiaa� oeo�. • <br />PuOlic Works Fee <br />Tolal Fae 5 - <br />Less AOP� Pee PaiE S n <br />eaiance Oue S G �� <br />��� / <br />/Iyr'//�.,� .� ,�v',•r./1 J�'�V� Qi[i+;a .-�/F. /_=vF,c/Y ycy�GJ.j 3�.�'=�`vl�� <br />Owner Mailing Address Ci�y Zip Phone <br />Sir/J1 [; J�i rlt <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work <br />Project Address (if known) <br />j'fic«/�Br <br />3309 <br />�� <br />�a� r�F:� <br />Attach four (4) copies of plans lor proposed work • Draw to scale ar,d note the tollowing as applicable: <br />• Property Lines • Centerline of stieat <br />� Outline end dimensions of all existing and • Indicate NoAh <br />proposed structures on the lot • SI ow any proposeA grading changes <br />• Exis�ing antl proposed utilities � Show measuremenls <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 hrs. in advance • phone 258•8815. <br />2. All work shell be pertormed in accordance with this permit and current City of Everett Design and Construction <br />Standerds and Specifications. <br />3. Call Locetion Underground 8ervice 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />i�, �.,� Pwa- <br />, �,. � �., e <br />�e�,.� s�nl��.Q „�.;Jl, <br />,.� ; �-k e x „-4 , �, � <br />�.�"�:I�i�� v`' 7 <br />Approved lor Constru � o�� Dale <br />� S�� <br />FINAL INSPFCII N Date <br />Approved as i;onstructed <br />everett PUBUC WORKS DEPARTMENT <br />� 3200 Cedar SVeet <br />Everett, WA 90201 <br />Phone: 259�8815 <br />� 1, s��- <br />C, �, <br />j 1.J0.1� <br />1 � v� e <br />�.i�9u�U� <br />T.^�J <br />W <br />� <br />� <br />� <br />O <br />ACKNOWLEDGEMEIJT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less the City ol Everett from any and alf claims (or dameges, costs, <br />expenses, or causes ot action that may arise because o1 installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice trom the <br />City and to rep�ace public propeily damaged thereby. <br />� ��s% �,So. d� <br />Signature ot Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITMIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAfTEP IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERh11T MAY BE <br />CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT Ob'ER 90 DAVS DURATION. <br />