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Cate .J�'.�i � � <br />Application For <br />PUBLIC VI/ORKS PERMIT <br />Print or Type Only <br />F� <br />IOQL(S� <br />Describe Proposed Work <br />Project Address �if known) � � <br />�d l9sos g�y '��'�' <br />� �E�fi <br />Mailing Address City <br />l4soa 8'{�faoc /��l✓ S�p. <br />Mailmg Address City <br />�i7- �I��RTM� <br />/ 4 '� I? l �tl� I�/ lt: <br />Puplic \Vorks ParmP � �`� � ��� <br />BIaq.Oept• �bT �� <br />� <br />PuDlitWorkaFee -- <br />Tutal Fee S <br />Less ApD� Fea Paitl S� <br />eeian<enue S <br />0 0� � % � <br />si77 54(0 -(o� <br />E 4g/77 <br />Atfach lour (4) copies of plans for proposed work - Draw to scale and n�te the lollowing as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions ol all existing and • Indicate Norih <br />proposed stru�tuies on the lot • Show any proposed grading changes <br />• Existing and proposeo utilities • Show measurements <br />PERMIT CONDITIONS <br />� <br />Phone <br />��-GIL�, <br />Phone <br />1. AI� calls lor inspection shall be made 24 hrs. in �dvance - phone 259•$$1 $, <br />2. All work shall be perlormed in accordance w;;n this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />fl ff�o.C'C G�fJ T.�/is <br />.$'E.�.9 • 'C7�-8.� <br />TE .�I,�.a�.siF,o <br />SiTE Sq,O� C Br OGx�E �'F.e <br />�'E!� Ui,E'Ein Eir//� /UOTEU GLt� <br />`S•�E7�'fi! <br />� ����/�-�-��� <br />FINAL. I�PECTION Date <br />Approved as Constructed <br />evcrell PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Siree� <br />EveretC WA gB201 <br />Phone: 259-8815 <br />HCKNOWLEDGEh1ENT OF CONDITIONS <br />►� <br />W <br />�"' <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less �he City ol Everett Irom any and all claims for damages, costs, <br />exoenses, or causes of action that may arise because ol installation <br />and mainlenance of the improvement or other righl�uhway use hereto <br />applied lor and luriher agrees to remove same upon notice irom ihe <br />City and to replace public property damaged thereby. <br />G��� �.� ��-r� - �s <br />Signa�ure of App�cam Da�e <br />WORK AUTHORIZED 8V THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED A��D THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETIOK. THIS PERMIT MAV BE <br />CANCELLED BY THE I;ITY UPON ANY S70PPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />