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Date�a �' - <br />"� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />I�'cN,�2o S <br />Owner <br />.4�0 4L� <br />� <br />ng <br />maumgnauress <br />c�tv <br />PUEIic Wo�ks Permd + �/ � � �� <br />BICp. D�pl. • <br />P�Mic Worka Fee <br />iolal Fae s <br />Leaa �DG� Fae PaiC S J' <br />BalenceDua t �^O� <br />Zip <br />tip rnone <br />Deacribe Proposed Work � e'� S�� p �d�O NT �/" /�B(,/� <br />��2AVFC .E'or?.ocv�9�/ ��4'or/cpE�, <br />Project Address (if knowo) <br />Attach four (4) copies of plans lor proposed work • Draw to r:ale and note the following as applicable: <br />• Property Lines <br />� Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />• Centedine ot street <br />• Indiwte North <br />• Show any proposed grading changes <br />• Show measurements <br />1. All ca�ls for inspection shall be made 24 hrs. in advance - phone 259•887 5. <br />2. All work shall be pertormed in accordance wilh this permit and current City of Everett Design and Construction <br />Standards and Specifications <br />3. Call Location Underyround Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�%��� TES' A.�E �T To .8E �qcE� <br />o.v c�ry P,eo.�F,e ry <br />i <br />(p.�o.�.o-T�' Gi.✓F �.t f,'v.�.aaX . � F,eoin <br />CE.riTE•e -ti•r/E Of' •�'0.9/�) <br />��-�%�Y��"r/l �6�— / /Z/i�� <br />Approved lor Co iructir,n Date <br />�Z � �7 <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPAR7MENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259•8815 <br />-'2, 3 / <br />ACKNOWLEDGEMENT OF CONDITIONS <br />✓ <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicanl hereby agrees to ho�d and save harm• <br />less the City of Everett irom any and al� cleims for damages, cost�, <br />e■penses, or causes of action that may arise hecause ol installation <br />and maintenance of the improvement or other right-ol-way use hereto <br />applied for and further a�rees to remove same upon notice irom the <br />City and eplace public pro rty dameged thereby. <br />° �,o--�r%-�� �- ,3.- �� <br />\� �u <br />S re of Applicant Date <br />WOR AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DI�IGENTLY PURSUEO TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLE� BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYFi DURATION. <br />