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Date_1 / ' � <br />Applicatton Fer <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�3crv <br />Describe Propused WorV: <br />ProJect Address (if known) ��/l — <br />Zip <br />Publlc WarAa Permil� 8�_ /�� _ <br />Biep. Depl. • �� <br />P���k WO�ke Fea <br />To�al Fna f _ <br />Lesi FpD� Fee Paitl s <br />Baiance Due .i 20��� <br />S �- <br />7� = �{�30 <br />F'hone <br />��P Phone <br />Attach tour (4) copies of plans for proposed work • Oraw to scale and note the lollowing as applica6le: <br />• Property Lines • Centerline of sireet <br />� Outline antl dimensions of all existing and • Indicate North <br />proposeA structures on the lot • Show any proposed grading changes <br />• Existing end proposed utilities • Show measurements <br />PERMI? CONDITlONS <br />1. All calls for irspection shall �e in�de 2J hrs in advance - phone 259•881 5. <br />2. All work shail be pertormed in accordance wilh tlils permii and current City of Everett Design and Constructinn <br />Stendards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-500-424•5555. <br />S: �EMOl�E E�f�S��A/6- l�.2/✓_ tcl,d`/ AT T//E N, E. Co,pNEie <br />pf'TiYE LoT Aa/D .PE'PLdGE GdiTN Fv[G HE/bHT Cu�CB <br />PE�2 Uy �f Evr. STdNOQ�CA '� .3�<0 #=3v-� <br />� �OOTi�vb�vOc�.� SPor�r �%ed�N L/NE CqN�/oT BE <br />Con/^1ECTE0 To TNc SinE SEu�E,2, <br />1/VSTdcL Ii�ESi.qrNTiqL S/OEGJd[.Cli�Pd�N PE.P C/Ty STQNQaRO <br />''� 3/9 , AND <br />,P�,�/ �oar�,uG � Dow,� y:ec�D,eein/ TD Sr,eEer Gu7/E.e,, <br />�, rNSTdLG f.�c:�'OSEO ��/�'El+/ef�S /�� C�ry � Ev6�j/ <br />STdNOD.C!� Pf�N -� .30% <br />W <br />� <br />� <br />—�rr�'�'i�0�j� <br />� • ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save ha�m- <br />X less ihe City ol Everetl irom any and all daims for damages, costs, <br />4, expenses, or causes ol action that may arise because of installation <br />� (O/ Z gs and maintenance of Ihe improvement or other right-of•way use hereto <br />applied tor and further agrees to remove s��ne upon nolice Irom the <br />(� pro d f onstruc!' n ate <br />City and to replace public property damaged thereby. <br />�����-�Z' � � _, ., <br />AL INSPECTION Date � <br />Approved as Constructed Signature of pplicant Date <br />everett PUBLIC WORKS JEPAFiTMENT WORK AUTH RIZED BY THIS PERMIT MUST BE S7ARTED VJITIi�N <br />� 3200 Codar Strnet 180 DAYS 0 DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />Everett, WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 3E <br />I U Phone: 259•8875 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK (`N THIS <br />PROJECT OVER 90 DAYS DURATION. <br />