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Date�L�" <br />Application For <br />PUBLIG WORf(S PERMIT <br />Print or Type Only <br />Owner <br />�escrihe Proposed Work <br />Prolect Address (il knownl <br />l4 N � �FT`` � �r„� .1�� <br />Mading Atltlress City <br />Idailing Address City <br />Zip <br />Attach lour (41 copies ot plans lor proposed work � Draw ;o scale and note lhe lollowing as applicable: <br />• Property Lines <br />• Outlinr and dimensions ol all ezisting and <br />proposetl structures on the lot <br />• Existing and prOpaSed utilitie5 <br />Puoiicwa�aaermn. �`� ?�/ <br />014�. Deot • ��� <br />PubbcWorssFee $ <br />ialai Fee — <br />lms P00� Fne PaiG $ <br />eaiance �ue S �� <br />• Centerline ol >Ireet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs. in aavance • phone 259-8810. <br />2. All work shall be pertormed in accordance with this permd and current Ciry c� Everett Design antl Consiruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />?,ANY CH(-1�IGE IN THE bFIVEWAY CUT t9UST HE APFFOVED <br />EY THE F'UHLIC WOfiK:S DEFARTPIENT. <br />g,USE FUPLIC DFAIN�ir,c S`lSTF_I1 AS �-iOVIDF_D FOR DOWNSF'OUTS. <br />G.A�Y LOT GRAPE CFIFNGES MUST BE F,F•PROVED PY THE <br />PU�+i_Ir I�IORS;:S IIVSPcr_TO�. <br />?,i'EE� CIT1' STnEET�. t='�EAP! AT ALL TIPIFS. <br />���oa-f� /v/ d8' <br />Approvetl lor Const uction / Da1e <br />FINAI INSPECTION Date <br />Approved as Constructed <br />everet[ PUBLIC WORKS DEPARTMENT <br />� 3200CetlarSlreet <br />Everett. WA 98201 <br />Phone:259�8870 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />z <br />0 <br />The undersigned owner/aPP6can' hereby agrees to hold and save harm- <br />less the Cdy ot Everett from any and all clams for damages. cosis, <br />expenses. or causes o� aUlon that may anse because of installallon <br />anC maintenance of Ihe improvement o� other ngh4of�way use herr.to <br />aPpiied for and luriher agrees to remo�e same upon nouce trom the <br />City antl to reUlace pubhc properry damageA Ihereby. <br />� ..-_J i1,c(��'' � /:�-/c S' <br />Si9nature of Appl�cant � � �'��� <br />WOpK AUTf10RIZED B1' THIS PERMIT MUSI' BE STARTED WITHIt! <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEP IS TO <br />BE DILIGENTLY PURSUED TO COMP�ETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />