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>HCA <br />H �H <br />K CJ <br />H� <br />H <br />IA H <br />H C <br />Mom <br />Nd <br />O H <br />H M d <br />O <br />Q. n <br />bHl <br />r z <br />HH <br />H <br />z H rn <br />1-3 ow <br />ri alit♦. <br />Date 7 2- u <br />Applicahon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />.1 <br />Public Works Permit a L/f—_�/� <br />Bldg pert a <br />Public Works Feu <br />Total Fee $ <br />LBS. Am[ Fee Paid <br />Wince rue S <br />ai Lf j ed L dl$ U a'>S <br />Zip Phone <br />Lip <br />3Y 7-d¢i� <br />Describe Propcsed Work mDdO tm((S r0_ LGt / 7xL Ik 1 4&Ck 4 L NA& <br />Project Address (if known) <br />Attach lour (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <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 performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications <br />3. Call Location Underground Service 48 hrs before you dig. TOLL FREE NUMBER 1.800-424-5555. <br />r <br />i <br />Approved for Cdinsfrupticn C •.r <br />FINAL IN— S� PECTION Date <br />Approved as Constructed <br />i <br />PUBLIC WORKS DEPARTMENT <br />Ever tt. WA Street <br />Everett, WA 98201 <br />Phone: 259.8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />U.l <br />r <br />rAer <br />03 <br />0 <br />n <br />F_ <br />U) <br />0 <br />CL <br />The undersigneu 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 -or -way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace publl Ioperty damaged thereby. <br />Signature of Applican S abate <br />WORK AUTHORIZE BY THIS P IT MUST BE STARTED WITHIN <br />160 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY Ft1R_JED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />ff <br />