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Date.��� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public 1Yorh9 P¢rymit a' �/ � / � <br />eiea. oao�. e � � <br />Publlc Wo�kx FOo $ �� � Q � <br />Tatnl Fea <br />Less AOP� Foe Poitl S <br />Dalarce Duo $ � ` � � <br />, ..,., <br />.� <br />Describe Proposed Wo�ti �1 /�� "�rL��' ' ` � C �, " L 5 ��C�C� <br />Project Address (if known) � � � '� � � � "` ` ' ' ' <br />Atlach four �4) copies of plans lor proposed work • Draw to scale and note ihe tollowinq as applicable: <br />• Property �ines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />! Existing and proposed util�ties <br />• Centerline of street <br />O Indicate North <br />• Show any proposed grading changes <br />• Show measuremenis <br />PERMIT 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 wilh this permit and current City ol Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />//lS/wc� /�-8- B3 <br />roved for Conslruction / Date <br />� � � <br />� <br />" / < -/' a !�`�c= S-z-F% <br />FINAt INSPECTION Date <br />Approved as Construcled <br />everett PUBLIC WORKS UEPARTMENT <br />� 3200 Cedar Slreet <br />Everett, WA 9820t <br />Phone: 259�8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />a• <br />The undersigned owner/applicant hereby agrees lo hold and save harm• <br />less ihe Ciry of Everett Irom any and all claims for uamages, wsts. <br />expenses, or causes of action that may arise because ol installation <br />and niaintenance of the improvEment or other right�ol•way use hereto <br />applied lor and turther agrees to remove Same upon notice from the <br />City �d to replace public pr6f7�+!9'jlama ��hereb\ <br />/ 1 �l / ,( 1 � <br />WORK THORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 D YS OF DATE PERMIT IS ISSUED AND THEREAFTEF IS TO <br />BE DILIGENTLY PURBUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED Bl' THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 JAYS DURATION. <br />z <br />0 <br />� <br />.� <br />n <br />m <br />—I T <br />..� <br />N 2 <br />m <br />0 <br />cv <br />m o <br />-i c <br />o m <br />-i z <br />x -1 <br />m <br />.o z <br />c <br />D —� <br />r x <br />.. .-. <br />--� N <br />-< <br />T <br />o� <br />�a <br />—i m <br />.L <br />ni � <br />N <br />o r <br />c� m <br />C N <br />� y <br />zn <br />—� r <br />• m <br />a <br />a <br />-� <br />x <br />n <br />z <br />� <br />� <br />N <br />Z <br />O <br />� <br />("� <br />m <br />