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�� >. <br />Date ' � �� "�� <br />Application For <br />F�UBLIC WORKS PERMIT <br />Print or Type Only <br />Address <br />rvia�nny r�uu�u55 <br />Describe Proposed Work <br />Project Address (il known) <br />ary <br />�- <br />C <br />.S- � 3 � <br />Attach four (4) copies ol plans lor proposed work - Draw lo scale and nole the lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />nuoin�.lYorks prrnnt n O �� (9 � <br />• �� <br />eia� oeo� '� ��~� <br />PUULc \yo�ks Feo <br />TotnlPoe 5 <br />LessAOPI. Fee PmU S <br />Oalance Duc $ �C�� <br />• Cente�line of slreet <br />• Indicate North <br />• Show any proposed grading chanc�us <br />• Show measuremenis <br />uU NUi WNIIt 6ELOW THIS LINE - <br />PERMIT CJNDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be pedormed in accordance with ihis permit and cu« ent Ciry ol Everett Design �nd Construction <br />Standards and Specilications. <br />3. Call Localion Underground Service 4B hrs. belore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />� /. R � //� �j /�p <br />t1 ��L� //7C/ �^v /G ' �"r7 Cl <br />Approved lor Construction Date <br />FINAL INSPECTION <br />Approved as ConsUucled <br />everetl PUBLIC WORKS DEPARTMENT <br />� 3200 Cetlar Slreet <br />Everett, WA 98201 <br />Phone:259�8610 <br />Date <br />�, c <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />_ / <br />� <br />O <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the Cily ol Everetl trom any and all claims lor damac�es. costs. <br />expenses, or causes of action Ihat may arise because of installation <br />antl mainlenance of the improvement or other ri�hbol�way use here�o <br />applied for and lurther agrees lo remove same upon no6ce Irom ihe <br />Cit and to replace pubGc property damaged ihereby <br />�. �-�,� z-�, -� <br />Signalure ol Appl c nt Ualc <br />WORK AUTNORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERh11T IS ISSUED AND THEFEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED BV THE CITY UPON ANY STOf'PAGE OF WORK ON THIS <br />PROJ[L'T OVER 30 DAYS DURATION. <br />