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Date � -�' B7 <br />Applicatio� For <br />Seti+ �4-�, �psi-,ruj <br />$— z-9/ <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing <br />Describe Proposed Work <br />cny <br />/ <br />� <br />PuOLc WorFs Pormil • ' � <br />BIOg Depl.s _ <br />Pu�i¢ Worke Fee <br />i ro�e� F�a s�3 60— <br />iase aooi. Fee v,��a s 60� <br />ea�a��« o�� <br />Phune <br />. aF 9 i/s �t'd f2c� r i'r �'O.� T�t/Gc:uUiN! .SYicEET .•L •c. <br />/J��.rcu .n6i,,.f <br />%A .SfEw/i/ .).� ... ,.. �. <br />?ro�ect Address Iif known) /��%— <br />Altach tour (4) copies of plans for proposetl work - D�aw �o scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposer; structures on Ihe lot <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />• Cenlerline of street <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measuremenis <br />7. All calls for inspection shall be made 24 hrs. in advance � phone 259-8815. <br />2. All work shall be perlormed in accordance with ihis permit and current City ol Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FflEE NUMBER 1-800•424•5555. <br />i <br />y �c,� ��<<-� �.�-, f�,�,��r , �� �=�, 9 j;-y� <br />!%'— , / <br />/�� _��/ <br />A n� e�c�,.�onstruc� Date <br />( � <br />. � �� !�� �- � <br />FINAL IN5T ECTION ' �a e <br />Approvr.d as Constructed <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Evere�;, WA 98207 <br />Phone:259-8815 <br />ACKNOWLGf uEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />0 <br />� <br />� <br />0 <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less thm City ol Everett trom any and al' claims for damages, costs, <br />ezpenses, or causes ol action that may arise because ot installation <br />and maintenance of the i�rovement or other right�obway use hereto <br />applied tor and lurt agrees to rem ve same upon notice from ihe <br />City anC to replac pu lic property darr�ged thereby. <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STAFTED WITHI,y <br />1d0 DAYS OF DATE PERMIT IS ISSUED AN� THEqEPFTEP IS TO <br />BE DILIGENTLY PURSUED TO COMPI.ETION. THIS PERMIT MAY 9E <br />CAN� [LLED �V THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER g0 DAYS DURATION. <br />