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Applica:ien For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Appficant <br />Describe Proposed Work <br />Proj^ct Aadress (if known) <br />AtltlrC55 <br />1 � n/r I <br />PubI�CWorhSP iq�fy�� G" �j <br />/ /� �]//. <br />61�8 DePI. � �� �K� �l � <br />Pubhe Wor45 Fee <br />iotal Fee $ — — <br />LessAOo� FeePaiO S — <br />eaia�c�o�� s Z��= <br />Phone <br />Lip Phone <br />Altach lour (4) copies of olans lor proposr.d work - Draw to scale and note the lollowing as applicable: <br />• Property Lines <br />• Outline antl dimensions ol all existing and <br />proposed structures on the lot <br />• Existino and proposed utilities <br />• Cenlerline of street <br />• Indicate North <br />• Show any proposed yrading changes <br />• Show measurements <br />PERMI7 CONDITIONS <br />1. All calls for inspection shail be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be peAormed in accordance with this permit and current City of Everett Design and Canstruction <br />Stendards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />��� <br />Ci/uv2caa-�j <br />4 <br />IoZ//,���(4n'>�.e..~�� `O�tGhGC.E• CLtG�CY�-! �U�QC¢i7/ <br />�sL CLC-Y�� —L'�!L// , <br />,��1fu� �o��� b'-5� 89 <br />Approved for Const ction Date <br />� C� .%../'`"j0 <br />FINAL WSFECTION �ate <br />Approved as Constructed <br />everett PUBUC WORKS DEPARTMENT <br />� 320o Cedar Sireet <br />Everett, WA 98201 <br />Phone: 259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />F- <br />� <br />� <br />O <br />The undersiqned owner/applicant hereby agrees to hold and save harm- <br />less ihe City ol Everetl Irom any and all claims for damages. costs, <br />expenses, or causes c: ac;:on Ihat may arise because of installation <br />and maintenance ol the improvement or other righFof�way use hereto <br />applied lor and lurther agrees to remove same upon notice I�om the <br />City and ro replace public property damaged ihereby. <br />� , / <br />� - �'% `' ; '' �� <br />Signature ol AppliCant / � Date <br />WORK Al��'HORIZED BY THIS PERMIr MUST BE STARTED WITIIIN <br />780 DAVS OF DATE PERMIT IS ISSUED AND THEAEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CA�CELLED BY THE CITY UPON ANY STOPPAGE OF WOf7K ON 7N!:i <br />PROJECT OVER 90 DAYS DURATION. <br />