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oate�a � <br />Appiication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />_1CiRlil'i % <br />Applicent Mailing Address <br />Describe Proposed Work <br />Project Address (if known) <br />City <br />Pupl¢ N'a�Fs Peimi� + �" <br />ama. o.ot . � <br />Pu�llc WorNf Fae S <br />Tolel Fea <br />Los� Appl Fae Paid S <br />Balance Dua S <br />ao� <br />Altech tour (4) copias ol plans lor proposed wcrk • Draw to scale and note the lollox•inp as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all ex�sting and • Indi:ate Noith <br />proposed structures on tha lot • Show any proposed grading thanyes <br />� Existing and pwposed utilities � • Sho�N measurcments <br />PERMIT CONDITIOVS <br />1. A�I cails lor ins��ection shall be made 24 hra in advance • phone 259•8815. <br />2. All work shall be perfornied In accortlance with this permit and current City of Ev2rett Design and Construction <br />Stantlards and :ipacifications <br />3. CrJI Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•$555. <br />J', EX�ST�*/f ��✓���?j/ Cli,er3 CvT T� B6 �EinovEv <br />ANO ��« h'�����fr LlJti'/3 �ES.✓-�9t[�D i�E.2 C/T�/ <br />ST9.�/49.eDS . ��b5 �' +�`306 <br />,s" A/E�.l 7>.e/vEw�+r To BE <br />C'/ f/ STA�✓D9.�1� �0'.�07 A✓D <br />�`y/�' � /�o/> <br />� Approved foi Constructio Date <br />'�%�.�j %/ �-�', � <br />FINA�i PECTION Date <br />Approved as Constructed <br />everett PUBUC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phone:259•8815 <br />1.dSTACLEO f�� <br />{�,r,e SEc>.a.d 3,�-7 <br />ACKNOWLEDGEMENT �7� CONDIT!ONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersi����d owner/applicant hereb� agr>es �o hold and save harm- <br />less ihe City ol Everett Irom anY and all claim for damages, costs, <br />expenses, or causes ol action that may nrise because of installation <br />and maintenance ol the improvemer' or other right•of•way use hereto <br />applied for and further ag; :es to remove same upon notice Irom the <br />City and to replace public property damaged thereby. <br />l_•L �, G.1 A� <br />S �alu�i Of Applicznt ' �----�c�� <br />WORK UTHORIZED BY THIS PERMIT MUST BE STARTED WITH�N <br />180 DAYS OF DATE PERMIT IS ISSUcD AND THEI?EAFTER IS TO <br />BE DILIGFNTI" ?i:!;SUED TO COMPL °TION. THIS PERMIT MAY BE <br />CANCELLED BY THF: CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS OURATION. <br />