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Date��� <br />Application Foi <br />PUBLIG WOR�CS P'ERIVIIT <br />Print or Type Only <br />licc� Address <br />ling <br />Describe Proposed Work <br />Prolect Address (if known) J�� <br />� o�,� . g' gl <br />City Zip <br />_- n <br />Puo:�clYarks Pcrm� <br />8 7- 3/� <br />9� beo� • �___y_ �_ � <br />+y-�,i, �n •. r -�� -� <br />PUEIit W� rks Foc <br />Total Fee S <br />Less Ap,il Fee PaiA S <br />�alanca0ue S Z�O^ <br />Attach four (4) copies ot plans for proposad work - Draw to scale and note Ihe following as applicab�e: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing 2nd • Indicate North <br />propeaed atraclures on the bt • Show any proposed grading changes <br />• Exlsting end proposed utiliUes • Show measurements <br />.�-.�z rr�� <br />Phone <br />�'—`13�f L <br />Phone <br />PERMIT CONDITIONS <br />1. All calis for inspection shell be made 24 hrs. in advance - phone 259•8815. <br />2. All work chall be performed in accordance with this permit and current City of Everelt Design and Construction <br />StanAnrds and Specificationa <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�i�, PNS%%9LG �� <br />/2 t�/.9n.�TE2 <br />/�/ l>� rC</ - Li�t/£ �/•v0.�.� <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everetl, WA 98201 <br />Phone: 259-88 7 5 <br />''o.vC.PF,� C�dE.e7 P/PE <br />D.Pi v£K/�q)/ <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />/�� <br />!�♦ <br />O <br />a <br />The unCersigned owner/, pplicant hcreby agrees to hold and save harm• <br />less lh�a City ol Everett from any and all claims for damages, costs, <br />expenses. or causes ot action �nal may arise because o! instailation <br />and maintenance of the imrrovement or other righPof-way use heretc <br />plied lor and further agrc to remove same upon notice from the <br />Ci and t�ce publi ��pe damaged hcreb� I���� / <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. TIiIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE Of WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />