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Date�d� 4� <br />.9pplication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />v � h�.� <br />Applicanl <br />Describe Prnposed Work <br />Prolect Atldress (if known) <br />Mailing Atldress <br />Mading AJdress <br />City Zip <br />IIPublic WoiFe Pcrm�it ♦/ ��"' —" O <br />8i�9 OeGI. • �_'i � � %� <br />Atlach lour 14) copies ol plans lor proposed wor4 • Uraw to scale ai.d note ihe �ollowing as applicable; <br />• Property Lines <br />• Outline and di�rensions of all existing and <br />pwposed structures on the lot <br />• Existing and preposed utili;ies <br />Pu�l¢ Wo�ks Pee <br />Totel�ee $ <br />less AOG� Fea Pai� $ <br />eai���e o�e 5 � � � <br />• Centerline ol street <br />• Indicate P�.orth <br />• :how any orc;iosed grading changes <br />• Show rre � �weroents <br />Phone <br />PERMIT C7NDITIONS <br />1. All calls lor inspection shall be made 24 hrs. m advance - phone 255 -i61 5. <br />2. All wo�k shall be perlormed in accordance with this permit and cu�rer t:�ty of Everett Oesign and Construclion <br />S.andards and Specilications. <br />3. Call'_ocation Underground Service 48 hrs. belore yeu dig. TOLL FREE NUMBER 1•800•424•5555. <br />`i , l,�-F. �ew�^ o�au.fi � euN� �1.�--� <br />s . s(w -� �,,�„ � �� � ,,�,�., � u„-,1,� � � <br />(o � ��f-s ,a,o c�.o no-{— �' `"".�<...�--��.�,r-vi�,.,,� �+.�fs <br />7 H cSO�L S �PE:o0.2T .�02 Tc�iS L LST <br />is ,�EQu-.�� dfF��� LG•�c,�E7� <br />�.c(' T./�" Foti.vof��'o•,.� ics fbwPc�.Z� . <br />���� � �� �� <br />Appr�or Construclion Date <br />' 7 ZT-�G <br />fINAL INSPECTION Data <br />Approved as Constructed <br />everclt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett WA 9820t <br />Phone: 259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />♦�A <br />V/ <br />O <br />a <br />1Pe undersigned owner/npplicant hereby agrees to hold and save hann� <br />b�ss the Ci�y ol Everett from any and all claims for damages, costs, <br />expenses, or causes ol action that may arise because ol installation <br />and maiNenance of Ihe impwvement or other riqht-obway use hereto <br />applied lor and lurther agrees lo remove same upon nolice Irom tha <br />Ci•y ,ind to repl�Ce Fublic property d�rBaged thereby. <br />Sic�m,fNre ol Applicant �! � DatA <br />WORK AUTHORI7_EL 9Y THIS PERMIT MUST B STARTED WITHIN <br />1°) DAYS OF DATE PERt�IIT IS ISSUED AND THEREAFTER IS TO <br />B'! DILIGENTL�' PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />C �NCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT Ol'E:a 3U DAYS DUNATION. <br />