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Date�� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing <br />� <br />Describe Proposed Work Y y= � Cl—�— <br />Project Address (if known) <br />PunetWodsPe� 88-3Z8 <br />B�e� oem • ' � <br />Pu�bc Woiks Fee <br />TotaiFae S ._ <br />Less Appl. Fee Paia S <br />� Pxlance Duv S �� <br />�trs'�i � �S�i—t� 1�[�1 <br />Zip Phone <br />2ip Phone <br />Altach lour (4) copies of plans for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines • Cer..�rline ol streel <br />• Outline and dimensions of 211 existing ai�d • Indicate Norih <br />proposed sfructures on thr. lot • Show any proposed grading changes <br />� Existing and proposed utiii'.ies • Show measuremenis <br />PERMIT CONDITIONS <br />1. AI� cnlls tor inspection s.iall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pertonned fn sccordance with this permit and current City of Everett Design and Construction <br />Standerds and Specifications. <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />i'�.u� l�i�o�� �' .��c.�u�a� �c.:c�:� C�-�t� <br />„�,, .,,. <br />,u�-ar-u��. <br />Approved as Consiructed <br />everett PUBLICWORKSDEPARTMENT <br />� °200 Cedar Street <br />Everett, WA 98201 <br />Fhone. �59-B810 <br />W <br />H <br />� <br />� <br />� <br />oe�3oiee 2=zawt uooaxzz�z �ii <br />� � <br />x000zos�s <br />e�.oc sss�.00 O <br />a.ec s�.00 <br />��, �.� a <br />PLH CH f67.2B <br />B SRCH f3.50 <br />E SRpi t15.00 <br />DRVWV t20.OD <br />�CKNO'NLED�Q��F CONDITIONS <br />The undersigned owner/appli�reby a� hold and save harm• <br />less Ihe Ciey of Everett Iron�yj�d �fjQ�y� for damages, costs. <br />expr,nses or causes of actioMf�atgnay����cause of installation <br />and mamtenance of �he impr o er nghFOFway use here�o <br />applied br and (uriher agre am pon notice Irom the <br />City and to replace public pr ama�by. <br />i _ 1 /7_� .. i�i�%.� / � <br />5i ature ol Applican� v / � Dale <br />W:�aK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />i80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCE�_LED BY THE C:1V UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />