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�1 � :' ��� <br />_ _ _..,......�---,:��_..._..._ <br />Date_1� I � � "''` �^ <br />Aoplicalion For <br />pUBLIC WORKS P�RNiIT <br />Print o� Typa Only <br />� <br />Describe Proposed lNork <br />Project Address (il known) <br />6lailinr, Address <br />Zip <br />Pu1�M1c4Vs 'S P^r^}'y�— <br />�(�-� 1%/`--�I <br />�Ir19 U�FI. � �t���{-1� —'- <br />v„m¢ woa� v�a --- <br />To�al FPC S __ <br />Less App� Fee �aA $ _ <br />dalancc Due $ <br />Attach lou�. (4) copie= ol plans lor proposed work - Draw io scale antl note the followin, as applicable: <br />• Properry Lines o Centerline of sire�t <br />• OutGne anJ dimensions ol all existing and • Indicate North <br />propoeed s�ructures on the lot • Show any proposetl grading changr,s <br />• �xisling and proposetl utilities • Shovi measurements <br />Phone <br />PERMITCO�DITIONS <br />�. All calls for inspection shall be made �4 h�a. in advance - phone 259•8810. <br />2. All work shall Le peAormed in accordance vii!h this permit and current City of Everett Design and Construction <br />Standards,:nd Specifications. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 9•$00•424•5555. <br />1 n-J� � � <br />.� (-������ /// //� <br />_ . . . ., ^;:. <br />� <br />fi - <br />Approved for Construc�ion Date <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everett,'NA 98201 <br />Phone: 259-8870 <br />'` � <br />cT, r < <br />q'. r '� :r <br />s { {r 'y::'. <br />. s.:,F_.� . <br />1 . <br />Date <br />W <br />� <br />� <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby a9rees to hold and save ha�m- <br />less the City of Everetl fwm any and all claims lor damages, c�sts. <br />expenses, or c2uses of action ihat may arise becaus^ ol installation <br />and maintenance of lhe improvement or other right-of�way use herelo <br />applied for and further agrees to remove same upon notice Irom ihe <br />City and to replace public property damaged thereby. <br />Signature ol 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 PUflSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRCJECT OVER 90 DAYS DURATION. <br />