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� .� `e_�'�`�d,G <br />d <br />ppplicatton For <br />- pUg��C WQRKS PERMIT <br />Print or Type Only <br />►� a <br />Owner <br />Dee.:ribe Proposed Work <br />2 2 0 or�K� <br />Address <br />�� �� <br />City <br />L1•J <br />_ ,3�8 <br />Pu011c Woikf Pe�mit � �� <br />eiac.000�.+ 'P---�� �%��_ <br />PUElicwo�kaFeo s <br />Tolel Fee <br />Lefa PPot Fee PeiU s �--�^��— <br />�� <br />9,I.ncoouo s = <br />� <br />5/��2 — �c%g,e�'i_. A�E <br />Pro�ect Address (it know^) <br />Attach four (4) copies of plans for proposed work • Draw to scale and note th �e �o��owing as applicable: <br />� C��ntedine of streel <br />� PropertY Lines • ;i�dicate North <br />• Outline end dimensions of all ex!sting and A g�ow any Proposed greding changes <br />proposed slructures on the lot � ghow measurements <br />• Existing and proDosad ulilities <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspeclion shall be made 24 hrs. in advance • Phone 259'88� 5. <br />2. HII work shall be peAormed in accordance with lhis permil and current City ot Everell Design and Construclion <br />Slandards and Specificalions <br />3. Call Location Under9round £-rvi�e 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•555 . <br />5l ,�oaf - To� <br />/��EFE/�f�d t y <br />D,QAi.c/A� masr eE <br />,,dro c.eEEK. <br />� <br />Approvedforconsuacu��� / � <br />��% � �� � � -/S�-� <br />Dale <br />F�{t SPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />EvereU, WA 98201 <br />Phone:259�8815 <br />CO.tJ��PoC L E..D <br />� <br />O <br />'"' <br />� <br />� <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett Irom any and all claims for damages. costs, <br />ezpenses, or causes of action that may arise because ol installation <br />and maintenance of the improvement or other right�ot-way use hereto <br />ypplied for and furiher aqfe� to remove same upo� notice Irom Ihe <br />�r�,,,�,rl.,m ertv damaged thereby. <br />�11-2�1 <br />Signature of APP�icam <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED W�THIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />PROJECT OVER 90 DAYS DURATION. STOPPAGE OF WORK ON THIS <br />� <br />