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----�.�..�-. —.�-,�- -- � � � --- - <br />., , , �,��. � <br />� <br />Date_���� � � , <br />Applir,ation For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� 1)1� <br />Applicant Mailing Address <br />acy <br />City <br />Describe Proposed Work � �D � � OF� ��� �l . ��c.���� � <br />Project Address (if known) <br />Attech lo.�r�4) copies of plans for proposed work- Draw to scale and note the following as applicab�e: <br />� Property Lines <br />• Outline and dimensions ot all existing and <br />proposed st�uctuies on the lot <br />• Existing and proposed utllities <br />PERMIT CONDITIONS <br />>,- �: <br />- � ,�: ;;:. <br />PubiicY:urksPermll+ L�� �� <br />BIEg Dept ♦ <br />Public Wa�ks Foe s <br />Totel Feo — <br />Les� AOP� FeP Paid $ <br />Balcnca Our S � <br />r.. <br />• Centerline of street <br />• Indicate North <br />• Show any proposed gr.��irg changes <br />• Show measuremenis <br />DO NOT WRITE BELOW THIS LINE � <br />1. All calls for inspection shali be made 24 hrs in advance - phone 259•881 5. <br />2. All work shall be perlormed in accordance with this permit and current City of Everett Desiqn and Construc�ion <br />Standards and Specifications. <br />3. Cell Location Underground Service 48 hra before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />STRE�'PS Aii6 'PC tsL rili?T CLLAR OF ALL ':L'll�i,'.'AVI'L��fdli i;7SC, llEHRIS AT <br />P.LL TIN,lS. <br />F`�ILI:RE TC KGEP THG PU9LIC R.0,1J. Ff:L•'E GF DE�RIS AND/M1;UD OR GftAVi.l, <br />t'�ILL Nf1:,ULT IN 'Pi1L' If•lidLUTATE' PUa'PII�G OF A S'I'OP �JOtZK CRDER Ot1 Tli[: <br />YltOJf::C^_' N'HICIi ti'ILL RRMrIIh It� FORCE UC:TIL ALL CLtiAN UP OF TIIC, R,C,��� <br />[; COi1PLETED TO '1'L'E SA�1'ISFACTIOL� OE 'PH� ?UCLIC 410RiC5 I;JSPr;C'PC".t <br />.(`'Fmov� cx�sy�ti�(s �1,c=�uFw�/j C��� cvr ,oE,�, c�rr <br />.s'�6L. � J..� 7 %it/O 1.✓S7/J4L ii/c'��J l�.c',�/cNAy �F.c� <br />CiT� G}� EiiE.�'F// Si�NO/�2'p � 07, <br />�� —� � . s� i � � <br />Approved for Constrya io Date <br />/ <br />FINAI INSPECTION <br />Approved as Constructed <br />everett PUBUC WORKS DEPARTMcNT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8915 <br />Date <br />ACKNOWL[DGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for dameges, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance ot the improvement or other right-of-way use hereto <br />apP�ied for and turther agrees to remove same upon notice irom the <br />City and to replace public property damaged thereby. <br />. {%� . � <br />��,�//�� ��!-.✓ L �' r � `-U �7 <br />Signature of A icant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WIThIN I <br />180 DAYS OF DATE PERMIT �S ISSUED AND THEREAFTER IS TO ; <br />BE DILIGENTLY 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 />