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Cr] M � <br />Q <br />>Hv~i <br />Kn <br />H 7J <br />04 H'�C <br />CA H <br />Z <br />S. <br />S <br />OH <br />H � g <br />17V <br />9 H� <br />Q H <br />H CA <br />HOrA <br />l <br />a � <br />S---7-Z8- 5 <br />r..l Application For <br />PUPLIC WORKS PERMIT <br />Q <br />0 <br />0 0 0 o TO POSTIN <br />Print or Type OnlK uci a o rn o o n o 0 <br />In C-I OO �+O OOO r- <br />.-r C+1 `0 U N ri rO OJ 1` 1 D- <br />•• <br />City <br />O DODWU] 0301` <br />Applicant <br />Describe Proposed Work W 5 F <br />Project Ad„ /ss (if known) <br />Public Works Permit <br />e G)t / t 5(-, <br />eltle Dept e <br />Public Works Fee s <br />Total Fee <br />Less Appt Fee Paid S <br />Nance Due S 2� <br />G. M <br />gwy #Z 3oEhel l 98otz- <br />Lop rnone <br />Attach four (4) copies of plans for proposed work - Draw to scale and n„ to the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8810. <br />2. All work shall be performed in accordance with 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 />PL-9, Mi,i:- . <br />�5-;1-7--5l <br />Approve .tor Construction <br />Dale <br />/ <br />/ <br />FINAL INSPECTIION <br />^ Da � t�e— <br />Approved as Constructed <br />PUBLIC WORKS DEPARTMENT <br />3210 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />Im <br />O <br />n <br />Z <br />O <br />O <br />an <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />K <br />