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Date_L9� 1 <br />Applicetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Applicant <br />Address <br />Address <br />Describe Proposed Work ' �� l— �� <br />Project Address (if known) �-�(JG — <br />Tcv B� � <br />Pu�lic Wodi Perm� • � jG/ <br />� � <br />eieo. oeo�. • � <br />PULIip Worb Fea <br />To1BIFea y — <br />lafe Ap.�.L Fee Peld a �j M <br />Belence Due s GO L�'�� <br />7a s�, <br />u <br />up rnone <br />Attach four (4) copies of plans lor proposed work • Draw to scale and note the following as applicable: <br />� Property Lines <br />� Outline and dimensions of all existing and <br />proposed structures on the lot <br />• �xisting and proposed utilities <br />• Centerline of street <br />• Indi�ata North <br />• Show any proposed grading changes <br />• Show measurements <br />P�RIAIT CONDITIONS <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 permit and current Ciry ol Everett Design and Conslruction <br />Stantlards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />c�/ �/cy/��'s T,C,Ci.fiG AGCESS To ic'ESCo�.vcE <br />MG ST �E '`�« � T''�N AK oc�.v� O.�/ S/TE, <br />T,y y vv,�c ib�vr �F PF,e,y,,,�v <br />O�t/TO %tiIU.F/tiCO .5'Llili, <br />�i /�'o��-y �0 ' f� <br />Approved for C nstructio��J /, a1e <br />�—� // _ -, ". , <br />as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 38201 <br />Phone:259-8815 <br />Ta [Y.4'C.e <br />ACKNOVo'LEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />� <br />� <br />� <br />O <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />Iess Ihe Cit�� of Everett Irom any and all claims for damages. costs, <br />expenses, or causes of action thal may arise 6ecause of installation <br />❑nd mainlenance ol the improvement or other right-ol-way use hereto <br />applied lor and fuither agrees to remove same upon notice Irom the <br />City and lo replace public property damaged Ihereby. � � <br />� � ( <br />�Q.�� <br />Lt,c�C_' CC�C�2 (�L% � <br />Sign W re of Applicant ( / "�•� <br />WO K AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />6E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT A7AY BE <br />CAPJCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER �JO DAYS DURATION. <br />