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Date��� <br />Applica:lon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing Address <br />City <br />Publlc Works Pcrml� s�� � V <br />BItlB� Depl. M � �__ <br />Pu01ic Works Fce <br />To�a� F � <br />Lass AppL Fee PaiE <br />aclanco oue <br />�..Q,OD <br />$ _ _ <br />g��.'� C.� <br />w" � � <br />- v-'/ 6 <br />Describe Proposed Work �-�`�'"" � �'�� <br />Project Address (if known) <br />Attach lour (4) copies of plans for proposed work - Draw to scale and note ihe followin� as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />• Centerline of sireet <br />• Indicate North <br />• Show any proposed graAing changes <br />• Show measurements <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259-881 5. <br />2. All work shall be performed in accordance with this permil and wrrent City of Everett Design and Construction <br />Standards and Specitications <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />��.t o.� ��� � �,..LLs}- b e s�- -b�� �.� e�o,.�s�.. <br />i <br />�ow N.d1�G a� p�1w��li-ao C31.v� �a.�lew.t� �O N�in. <br />-�-�,o,h— c o.-r� Go �..�1� b e � cu�c e� i:. �ro �.. �� <br />���_ WKCJ� ✓lO� Q.NC��00..� �r� �Q�iQ/I <br />`,q,nes. <br />-�✓t�/�-- /1-�-�J <br />pproved for Consiruction � , Date <br />J //� <br />%�-/C .- � �lL--�' .� �� - ,%"Y <br />F�C INSPECTION Date <br />Approved as Constructed <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259�8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />N <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />less lhe City of Everett from any and all claims lor damages, costs, <br />expense� or causes of aclion that may arise because of installation <br />and maii.ienance of the improvamenl or other right-o(-way use hereto <br />applied for and lurther agrees to remove same upon nolice froin the <br />CilXand to replace public Property�lamaged thereby. <br />Si ature of Appljyanl `///`.� ua�e <br />ORK AUTHORIZED BY TF11S P RMIT UST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS�ISS ED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />z <br />0 <br />-i <br />.. <br />� <br />m <br />.. .. <br />--1 T <br />�-. � <br />�, _ <br />0 <br />m <br />co <br />m o <br />-i c <br />oa <br />m <br />i� <br />m <br />.O Z <br />� _ <br />.. .. <br />--i tn <br />-� <br />� <br />on <br />= m <br />m� <br />� <br />0 <br />o r <br />r+ m <br />�� <br />_ N <br />'m <br />z c� <br />-i r <br />m <br />n <br />A <br />� <br />2 <br />D <br />Z <br />--1 <br />2 <br />N <br />Z <br />0 <br />... <br />n <br />m <br />