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� � H <br />b <br />p G <br />M <br />7 H N <br />� <br />N M <br />� H � <br />o�o <br />� N M <br />� y � <br />� � �c� • <br />b H � <br />n <br />k 1-I H <br />N <br />p C N <br />�q �y tr9 <br />H O N <br />� �� <br />Cete�� <br />Appliwtion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />r�,:,-.,, �va�A: vo�„n • �� - <br />o�e�� oon�-• ��–(f/�� <br />Vu�i�cWniksFee ,$ <br />Tolal Gec <br />Less Ao�l Fee Pa�il $ — <br />BalanceDuo _S _ <br />�/d �—(0.7�� _ <br />ZiP Phonr� <br />%7f1/�^ //� - <br />Applicani klailin9 Address City 2ip Phonc <br />Dcsc�ibe ProPosed Work _—�.r�� �n^ �,a—.���� �`a�– <br />ProlectAtldress�ilknown� _,j�_8���,..�(i��.fQl���T <br />Ntech lour 14) copies ol plans lor p�oposed work - Draw to sule antl note the lollowing as applicahle� <br />• Property Lines <br />• Ou�line and dimensions ot all ezisting and <br />p�oposed slrucWres on the lot <br />• Existing and propo5ed ulililics <br />• Centerline ol siree� <br />• Indicate Norlh <br />• Show 2ny proposed gradin�,i chanyes <br />• Show measuremenls <br />1 PERMITCONDITIONS <br />�� 1. All calls lor inspection shall be made 24 hrs. in advance - phone 259•8810. <br />� ' 2. All work shall be pedormed in accordance wilh ihis permit and curtent City ol Everett Design and Construclion <br />'� Standards and Specifications. <br />� 3. Call Location Untlerground Service 46 hrs. belore you di�. TOLL FREE NUMBER 1•800-424•5555. <br />__ <br />c/�� - t /�� ��� �.�.�z<<�� <br />� L��=������ � <br />`��� /XlLz.1�z� <br />�� �. <br />Z–Z�Z'%� <br />APprove� for Consiruction <br />FINAL INSPECTION Date <br />APProved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Evcrelt, WA 98201 <br />Phonc 259�8810 <br />ACKNOWlEOGEMENT OF CONDITIONS <br />Z <br />O <br />r <br />� <br />O <br />a <br />The undersigned owner/apPGcant here6y ac�rres to hold and save harm- <br />less ihe City o! Everetl iwm any and all claims lor damages, costs, <br />eapen5e5, or causes ol acllon Ihal may arise beCause ol inStallaUon <br />and mamtenance of the improvement or olher right�of�way use herelo <br />applied for and further aarees to remove same upon notice Irom Ihe <br />C'.ly and lo replace public property damaged thereby. <br />SignaWre of Applicnnt Datc <br />WORK AUTHORIZED �V THIS PERh11T MUST BE STARTED WITHIN <br />180 DAYS OF DATE P[RM111T IS ISSUED AND THEREAFTER :^ TO <br />BE OILIGENTLY PURSUED TO COMPLETIO�. THIS PERMIT h1AY 3F <br />CANCELLED BY THE CITY UPON ANY STOPP�GE OF WORK ON THIS <br />PROJECT OVER 90 Dr1Y5 DURATION. <br />