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� i@ , / /'� <br />qpplicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only , � <br />�i <br />Describe Proposed Work <br />project Address (if known) <br />City <br />City <br />Publ¢ Wo�ks 7o�mlt • �( � � ��� <br />e�ae� oeo�� • <br />Pu01ic Wo�ka Fce S —__ <br />Tolnlfoe <br />Less PpO� Foe Pai� $ ��— <br />eaiancaDuo S �O� <br />� jED �L✓� <br />� oS/ <br />Atlach tour (4) copies of p�ans lor Proposed work • Draw to scale and note Ihe following as applica6le: <br />• Property Lines <br />• Outline and dimencions ol all existing and <br />proposed slru (o �osed ihl ties <br />• Ezisting and p P <br />�e��'��a�3 �� <br />Phone <br />Phone <br />L� ��J• <br />• Cenlerline o� streel <br />• Indicate NoAh <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />5. All calls lor inspeclion shall be made 24 hrs. in advance - Phone 259•88 <br />2. All work shall be pedormed in accordance with this permil and currenl Ciry of Everett Design and Conslruction <br />Stendards and Specifications. <br />3. Call Locetion l�nderground Service 48 hrs. before you dig. TOLL FREE NUMBER 1'801�424'� ' <br />� �ct/f-��"'� Ynaof' �e s-��� <br />CoZo/j B2° "� �'i `'� � ° .��' <br />/ 4tva-j �0')+'� <br />�, , , „ /a,CR C(//i2r.�i a f� p <br />rn� �� v <br />Approved for G <br />�� <br />as Constructed <br />everett PUBLICWORKSDEPARTMENT <br />� 3200 Cedar Slreet <br />Everelt, WA 98201 <br />Phone:259�8810 <br />�U <br />Date <br />swaY�d' "� <br />g?vd./�,�o dv,a.c� <br />�j2tK�f' LCUu'a/. <br />W <br />H <br />- <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less Ihe Ciry of Everetl irom any and all claims for damages, costs, <br />expenses, or causes ot action lhat may arise 6ecause ol i�stallation <br />and maintenance of the improvement or other right�ol-way use hereto <br />ypplied for a�d luriher agrees to remove same upon nolice Irom th�: <br />Y, replace pu property damaged thereby. <br />i� d <br />�. /� � ., � /�- �D- <br />Si�na re ol Applicant <br />y� K AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />PROJECT OVER 90 DAYS DUR T ON. STOPPAGE OF WORK 0� THIS <br />. <br />