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..._. - -- - <br />, �ate���i <br />� <br />Ap011catlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Cny <br />memng naaress <br />Describe Proposed Work <br />Pro�ect Addresa �il known) �J — <br />Pusuc WarM Pe�mA • `-' � / � <br />Biep o�o� • �� _ <br />! I <br />Pub�m wors� fea <br />7mMlee { <br />Ln� �p0� !aa P�b / <br />B�bnq Due { <br />ZD� <br />Phone <br />Attach four (4) copies ol plans for proposed work • Draw to scale nnd note Ihe lollowing as appliceblo: <br />• Property linea <br />� Oull�. .e and dimanslons ol all eKisfing and <br />proposed atr�ciures on the lol <br />• Exiating and proposed utilitiss <br />PERMIT CONDITIONS <br />1. <br />2. <br />� <br />• Centerline of sVeet <br />• InAicate North <br />• Show any proposed graAing chnnpes <br />• Show meaeuremPnts <br />AII caile lor inspactlon shail be made 24 hra in edvnnce - phone 2S9•B$i 5. <br />All work shall be perlormed in accordence with this permit and currenl Cily ol Everett Desipn and Construcllon <br />Sfantlards and Specilicalions. <br />Call Location Underground Service 48 hrs. belore you dip. �'�LL FREE NUMBER 7-800-424•5SSS. <br />1 a/Si,9cL f7.� ldE'i�:5 , a ��SS/,oATE <br />y � ,P�„� w.9rr-z <br />�O/77 GC/li�.<.."� Ai✓,C f. -�C�T..✓Cr l�h�f%it/S <br />CyJt�/=- .c�c�a� �/—'�6 <br />Approved br Construction Uate <br />� `O <br />FINAL INSFECTION Date ' <br />Approved as Consiructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />�verett. WA 98201 <br />Phone:259•8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />H <br />� <br />O <br />a <br />The untlersigned owner/appl�cant here6y agrees to hold and save harm- <br />less the City ol Everett Irom any and all claims for Oamages. costa <br />expenses, o� causes ol action that may ari6e because ol installation <br />and maintenance ol the �mprovement or olher righl•ol�way use hereto <br />appli lor and furthe� eprees to remove same upon notice Irom Ihe <br />C� &nC (� replace pub�ic proper�rQRj�epBd ihereby. <br />WORK AUTHO�ICED BY THIS P'cRM1T MUST B[ STARTED WITHIN <br />1B0 DAYS OF DATE PERNIT IS ISSUEG AND THER:AFTEH IS TO <br />BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCEILED 81' THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. � <br />