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Date��.q <br />Applica�i0n Fof <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />$' p IL1 8 <br />Applicant <br />- F6 t`' S+Sc C✓e� <br />Mailing Atldress Cfty <br />Mailing Address City <br />Z+n <br />� <br />PUGImWpr:�SPerm�fla /v/ p/�T�/� <br />8��9 DeP� . if 9/ �—/�}=/ —'. <br />—"•T <br />Puehc Works Fee - <br />Totql Fec s _ <br />Less ApD� Fne Pai� S <br />�aiancrDuc $ �C �� <br />.6S< <br />Phonc <br />Phone <br />DescribeProposedWork �e�J fY�k ��%j�pC /� %;P_/.p�/����j['���� �^�/ � <br />� <br />� <br />P�ojed Adtlress �if known) � J 2� ��� R <br />Attach four (4) copies ol plans for proposed work � Dr�w lo scale and note the tollowing as applicable: <br />• Property Lines <br />� Outline and dimensions of all existing and <br />proposed strudures on the lot <br />• Existing and proposed utilities <br />� <br />FINAL INSPi <br />Approvetl as <br />everett <br />e <br />• Centerline of sireet <br />• Indicate Norih <br />• Show any prcposed grad�ng changes <br />• Show measurements <br />FERMIT CONDITIONS <br />1. All cells for inspection shall be made 24 hrs. ir. advance • phone 259•8810. <br />2. All work shail be peAormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Undarground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />' l'.f;.��czf� .��" � 5'v <br />;onstiuction / Date <br />/ ,. <br />..�-lt% ��� � e�� fj' <br />;TION Date <br />onstrucled <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett WA 99201 <br />Phone: 259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned cwner/applicant hereby agrees to hold and save harm• <br />less the Gty of Everetl Irom any and all claims for damages, costs. <br />expenses, or causes of adion that may arise because of installation <br />and maintenance ol Ihe improvemenl or other righ�-ohway use here�o <br />appli2d r antl furthe� agree to remove same upon notice f�om Ihe <br />City ai o replace public pr �erty d age thereby. <br />� �/���5 <br />Signature ol Applic�ht � Date <br />WORK AUTHORIZED BV THIS PERMII NiUST BE STARTED WITNIN <br />180 DAYS OF DATE i ERMIT IS ISSU[D ANL THEREAFTER IS TO <br />BE DILIG[NTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />