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Date��S�f�'� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Malling Address <br />�',�!o�cWa��.sPrrnn _ <br />[t.cf� Den� • � ����T.,�'�a - <br />punLc Woas Fee g <br />TO�PI FCB <br />Le55FOPl FcePmtl S <br />OdIT�CODVE $ <br />-z� �-_51`—' i1�� <br />z�� �ho�,� <br />DescribeProposedWork ,�-��i t �✓i — 'Y�� i' % Pb���•x ___ <br />Proiect Adaress (il known� <br />Attach lour 14) copies ol plans lor proposed work � Draw to scale and note ihe following as applicable: <br />• Property L1nes <br />• OWlinr. and dimenslons of all existing and <br />proposed slrudures on ihe lot <br />• Existing and proposed Wilities <br />• Centerlir.e ol street <br />• Indicate North <br />• Show any propo5ed grading changes <br />• Show measuremenis <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 perlormed in accerdance wi�h ihis permit and wrrent City ol Everett Design and Consiruction <br />Standards and Specitications. <br />3. Call Location Undr.rground Service 49 hrs. belore you dig. TOLL FREE NUMBER 1•$00•424•5555. <br />Approved lor Construction <br />Q /� I L ��� <br />���/J��� WU�� .�-. <br />��i�/99/% /�✓Q/ . <br />4'��7'✓/.^ f'"✓ <br />( �( � �J <br />'J <br />�� <br />,�,- , <br />� ��J��� - -Y����i � <br />� C�l�tic r i�/rT,= �.:. <br />j�j'riif.G' T /7i%i.., <br />--�— <br />� ������� !,�1� f; (.� !)./i.,r,i �, z ii1 H <br />FINAL WFPECTION <br />Approved as Constructed <br />everett PUBLICWORKSDEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Pr�one. 259-0810 <br />I�lls F; <br />VOWLEDG[MENT OF CONDITIONS <br />W <br />H <br />N <br />� <br />O <br />• w <br />7 I <br />� <br />a <br />mer/apPliCant hereby agrees to hold and save harm- <br />�erelt Irom any and all claims for damages. costs. <br />:s of aclion Ihat may arise be�ause of installation <br />il Ihe improvemenl or olher right-of-way use hereto <br />iher agrees lo remove same upon notice hom �he <br />public property damaged Ihereby. <br />Signature of Applicanl Datc <br />WORK AUTIiORIZED BY THIS PEFMIT MUST BE STARTED WITHIN <br />180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />B[ DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 8[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF 1NORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />