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Date n �� �� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />116�' SC <br />Address <br />--�, <br />Bla¢ Dep�A. Fermlt� � � .3 %� <br />i� <br />Pubiic Worke Fee s <br />Totel Fae <br />Lese RpO� Fea PaiE S �� �/ <br />Belanca Due s —�.--� <br />'�` c Q�e�t� �-fs�-la'8G <br />Zip Phone <br />� Mailing Address City Zip Phone <br />Applicant <br />Describe Proposed Work <br />Pro;ectAddress(ifknown) •� � �-�-- `� '� <br />Attech four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline end .i��nensions of ell existing and <br />proposed structures on the lot <br />• Existing and proposed utilities <br />• Centerline ol street <br />• Indicete Norih <br />• Show any propcsed grading chenges <br />• Show mea[urements <br />PERMII� CONDITIONS <br />1. A�I calls for Inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shell be performed in accordance with this permit and currenl City o� Everett Design and Construction <br />Standerds and Specificetions. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800-424•5555. <br />� S'iTC G!/L'.F'.E" %� a F CO�JS: L'vcTEG� �-�.e <br />�ji�.'c�!/EO /�CNNS GiATE� /� -�- b"S <br />s 9���,�a.�- <br />Gva,�vti y <br />/79l1.'S'l P.�'Os��Lt� /i /�ct.P.<O/�..n� .t/c`C� <br />F,c� TifF CU.t,d 6v7�E.c' � S��WaC'C" <br />�71�aG B?oz��iy /.: �-•ln -.9S <br />Approved for nsiruction Da�e <br />FINA��,�i� � �L -�, <br />TION Date <br />Approved as Consiructed <br />everelt PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259�8815 <br />ACKNOWLEDGEMENT OF CONDITIC <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />0 <br />a <br />The undersigned owner/applicaN hereby agrees to hc _ .1 save harm- <br />�ess the City of Everelt irom any and all claims for Oamages, cosis, <br />expenses, or causes ol aclion that may arise because of installation <br />and maintenance of �he improvement or other right-of-way use hereto <br />applied for and turiher agrees to remove same upon notice irom the <br />City and to replzce public property damaged ihereby. <br />/�'�-r�i��O�u�� 7 3-8� <br />Sign ture of ApPlicaM Date <br />V.'ORK AUTHORIZED BV THIS PERMIT MUST BE STARTED W�THIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLV PUR:iUED TO COMPLETION. THIS PERMIT MAY BE <br />C.INCELLEO BY THE CITY UPON htJY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATICN. <br />