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Jate�lS�Fr] <br />� � � <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Oi:., <br />City <br />cny <br />Describe Proposed Work <br />ProJect Address (if known) <br />Publ¢ WnrMs Pa�mil • ✓ � �r <br />BI40 0001. t _ �%� � <br />r�nu� wo�k. Faa s <br />Tolel Fon <br />Lesa AppL Fea PnIJ S— <br />6eiencaDue S a� <br />Attach four (4) copies of plans br proposed work • Draw� to scalo and note the followmg as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot � Show any proposed gradin9 changes <br />• Existing end proposed ulllifies • Show measurements <br />PERMIT CONDITIONS <br />-11i- 7If;�-- <br />Phone <br />1. All calls tor inspection shall be made 24 h�s. in advance • phone 259•887 5. <br />2. All work shall be pertormed in accordance wilh Ihis permit and current City of Everett Design and Construction <br />Standards and Specificstions <br />3. Call Location Underyround Serelce 4B hrs. before you dig. TOLL FREE NUMBER 1•SOO•424•5555. <br />�! �'ooF-T� aow.�s��o� �wsT a� r�v�.ti.�� ro <br />c,rE-�,� a.�.� (s.d�.ss�.� e«rs �t/aT AGP,eovE1� ,�, <br />T.s%s [oc�ro.�/) <br />��(/C'G(/�7 /7�'J-� ��P� _�- <br />�� � C// �/ /��i <br />—� lj'iiu C S"` �li —� L 7 [�JUr/�cy '� <br />FINAL IN$P�ECTI6N <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phone: 259�8815 <br />Dale <br />ACKNOWLE�GEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />Iess the Cily of Everett Irom any and ail claims lor damages, costs, <br />expenses, or causes of action that may arise because ol installation <br />and mainfenance ot the improvement or olher ric�ht�ohway use hereto <br />applied for and lurther agrees to remove same upon notice from the <br />City and to replace public property damaged Ihereby. <br />�Q� "�-/-� C � ��i� <br />Signalure of Appli t Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STAFTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THERE�FTER IS TO <br />8E DILIGENTLY PURSUED TO COMPLETION. ThIIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUh �'ION. <br />