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�ateAria.�t�i.i , i 495 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Ran Rurt I 1'L3 W_ Mukiltea Blvd <br />Everett, Wa 98203 <br />(�r �� / <br />PUEIic Works Perm�t � ��Ldq--- <br />emy. oeo�� • <br />PubbCWo�kSFee s <br />Tolal Fee <br />Less Poc� Fae PaiO S� <br />Balance Due s I � <br />� <br />Owner Mailing Address City Zip Phone <br />Applicant <br />Describe Proposed Work <br />Prolect Address (if known) <br />Mailing <br />Fill not to exceed 50 cu <br />City <br />fC�S. <br />Attach four (4� copies of plans for proposed work • Draw to scale and note the following as applicable: <br />• property Lines • Centerline of street <br />• Outline and dimensions ot all existing and � Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />S <br />PERMIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be peAormed in accordence with this permit and current City of Everelt Design and Construclion <br />Standards and Specifications. <br />3. �all Locetion Underground Service 48 hrs. before you dig. TOIL FREE NUMBER 1•800•424•5555. <br />�j, F�I� SV��,II b� Plttced�v� uman��C�'' �I��� doe5 nt� 2d�e�s�y <br />a-FFer� ad�o�-� ��� �ro�rt�e� . F,i( ww� be pl�ced.o�� <br />dN/he,rs ��p�� on����23 vJ, r1ok��ktA 6►vd�. <br />J::':;,'9� _� ^4`'M ^.::'9�G'Ji <br />Date <br />-------G- �- y r <br />— Date <br />Approved as Constructed <br />����PUBLIC WORKS DEP.4RTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />:f�l)�95.�'_�'= <br />�:T�!Es ��5.�]n <br />=1;�, t,:.5._7 <br />W <br />H <br />� <br />� <br />� <br />0 <br />r�� <br />VI <br />O <br />a <br />ACKNOWLEDGEMENI ,iF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City ol Everett liom any antl all claims for damages, costs, <br />e+epenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of•way use hereto <br />applied for and turther agrees to remove same upon notice Irom ihe <br />City and to replace public properry damaged thereby. <br />^��,�_ %1� 5-3�-�.� <br />Signature of Appli ant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUR6UED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOFPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />