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Date �/�, /�g <br />� � <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Applicant <br />Describe P�oposed Work <br />Project Adtlress (il known) <br />Mailing <br />Mailing Address <br />iQ <br />Cny <br />� W. %"1U�/LTEO b�G!/U <br />Attach lour (4� copies of plans for proposed work - Draw to scale and note the tollowing as applicable: <br />• Prope:ty Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Ezisting and proposed utilities <br />PuEuc WarMs Permn • �> �'"' � <br />Bltlg. Oept s `- C <br />Pobllc Warks Fee <br />ioiel Pee S <br />lecs ApP�. °ee Paitl S <br />BaianceDue S 2� <br />• Centerline of slreet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDII'IONS <br />1. All calls for ir;pection shall be made 24 hrs. in advance- phone 259-8810. <br />2. All work shall be peAormed in accordanc=with this permit and current City ol Everetl Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 46 hrs. before you dig. TOI.L FREE NUMBER 1-800•424•5555. <br />CL�xa-�� li�..��� �is..v a�s.ov�� /O' w..ca� <br />�� .�D �crJ <br />r�,�� .� <br />���� <br />��i� a� �i� G�/Ztue.c.l� - �e t.�tt/�A't— <br />�-tc.(.�L�� Ge/0�.� .'`�v�e�'"o-i .�i <br />�.� �� �o <br />Approved fcr Constructiot��� / ate <br />��.� [v' �-� <br />FINAL INSPECTION Date <br />Approved ae Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everett, WA 98201 <br />Phone:259-8810 <br />za� <br />ACKNOWLEDGGIdENT OF CONDITIONS <br />� <br />� <br />� <br />�J <br />� <br />� <br />0 <br />a <br />The undersigned ownedaFPlicant hereby agrees to hold and save harm� <br />le5s the City ot Everetl from any and all claims lor damages, costs, <br />expenses, or causes of aCtion �hat may arise because ol installation <br />and maintenance of the improvement or other right-obway use herr.to <br />applied for antl lurlher agrees to remove same upon notice from the <br />�City a to re�lace public property damaged Ihereby. <br />.�.�.- �s-�-a--e-� <br />Signa�ure ol pplicant Date <br />WORK AUTH RIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF pATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE OILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCEILED BY THE C�TY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />