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Date��� <br />App�ica!ion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />1��„�,�;�. r� i�1° <br />oW�e� <br />�'�1 \`\ � <br />App �cant <br />Describe Propo ed Work _ <br />Prolect Address (if known) C <br />Address <br />Address <br />Publit Worxs Permlt + �'� /� �/ <br />eiae oeo�. • <br />Public Works Fne <br />iotal Fee s <br />Lass Appl Fea Peid S <br />ealance Due s -2f% �O <br />Oo Z- 3 22- yC' -ono- //- B3/ <br />�r� i?I�d S-�C��,7 S� <br />Ciry Zjp <br />.�- <br />� � ._ <br />City 7{p <br />Phone <br />s �-,��� <br />Phone <br />\ � <br />Attach four (4) copies of plans for propused work - Draw to scale and note the lollowing as applicable: �OOQ�F9594 <br />• Property Lines • Centedine o( street DRV4A1 4?0.00 <br />• Outline and dimensions of all existing and • Indicate North �HLCI: $�0.00 <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed uti�ities • Sho�v measurements <br />PERMITCONDITIONS <br />1. All cails for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shell be performed in accordance with this permit and cu«ent City of Everett Design and Construction <br />Standerds and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TQLL FREE NUMBER 1•800•424•5555. <br />y �'� ��, � d�� u� �c�. <br />��� .�:�h� -o,� w�,y ����.., � �o�, � <br />� -� � �.� � ,�,.� ,�. <br />� -z� �, / /G-9/ <br />Approved lor onsVuc ' ---- � Date <br />/o el /� 9i <br />FINAL I EC ON Date <br />Approved as Constructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8010 <br />ACKNOWLEDGE�IENT OF CONDITIONS <br />� <br />� <br />� <br />� <br />0 <br />H <br />� <br />O <br />a <br />The undersigned owner/apPlicanl hereby agrees to hold and save harm- <br />tess the Ciry ol Everett lrom any and all claims lor damages, cosfs. <br />expenses, or causes of action ihat may arise because ol inslallation <br />and mainlenance of ihe improvement or o�her rlghbof-way use hereto <br />applied for and fw�her ag�ees to remove same upon not�ce Irom the <br />Ciry and to replace public operty, amaged �hereby. <br />� '"� t���`N;'��i`.�i ����'��/ <br />Signature of ApPlic/atit / / Date <br />WORK AU7HORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS 70 <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY �3E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE Of WORK ON 1HiS <br />PROJECT OVER 90 DAYS DURATION. <br />