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Date_s1r P <br />/ <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Works Permits • Zo + <br />Bldg Dept. s <br />Public Works Fee § <br />Total Fee <br />Less Appl. Fee Paid $ SZ <br />Balance Due $ <br />Describe Proposed Work c1✓t lJr fj U '' .Lr f C yPa Miad. ( (- romLL70V1 )i- lea LC _ <br />Project Address (if known) —1Y0� <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines O Centerline of street <br />♦A <br />• Outline and dimensions of all exiating and • Indicate North <br />v+ <br />proposers structures on the lot a Show any proposed grading changes <br />• Existing, and proposed utilities • Show measurements <br />t�s <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />1. All tills for inspection shall be made 24 hrs. In advan--e - phone 259.881 5. <br />1102 <br />2. All v ork shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Ste ldards and Specifications <br />3. Call Location Underground Service 48 hrs before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />z <br />-E <br />fG.y�✓S .Ci97r'� G-8-87. <br />l�.P,q..u4ri6 FEE 7o e4E REiins3U.B.SEO /F A, .o.�Gie q�Y Cyi/ <br />f�Pov. of l'Poaf G 0�6�Q (-fly 7Z;9F E.v[D OF rre IPS7) i&,9T <br />4 <br />Ti/E EvEPE�l h�A[G's dL�. �✓Sio i/ /�onZoS /9PE t1 E04/9T6' T� <br />o <br />S'%Gr?E EXTiP9 �UN—Of�%%l" �c9Z(o sl, <br />ACKNOWLEDGEMENT OF CONDITIONS <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 removo same upon notice from the <br />Approved for Corisxucti9n) f Date City and to replace public property damaged thereby. <br />Date <br />Approved as Constructed lJ <br />everett PUBLIC WORKS DEPARTMENT <br />4` 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />Signature oJAp Mail Date <br />WORK AUTH IZED BY THIS PERMIT MUST BE STARTED WITHIIi <br />180 DAYSq� DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGE TLY PURSUED TO COMPLETION. THIS PERMITMAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />