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Date i��� <br />� � <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Zip <br />D�,N �jv��L�e�_.�,'�..c.�. <br />Mailing Address <br />P�oim wo�ks oe�mn . �5�� <br />eiav Deo�- • <br />�t WorkB Fee <br />� To1Bl Fee_ S — <br />Le�a �pD� Fee PeiE s A' <br />:9alence0ue s ,V� «��'+F <br />� <br />Phone <br />z�2-1��� <br />� ���r - <br />!s',/3— <br />DescribeProposedWork Pl%T DUnnpSrE,2 I�J TI�E QILC� %/L %rS�// Cj�� <br />Project Address (if known) �. � � � • �I1,S�-�. ����-� � > ' . � � �1 c <br />Attach lour (4) copies ot pla�s for proposetl work - �raw to scale and notu the foll wing as applicable: dg�y- WCTm <br />• Property Lines <br />• Outline and dimensions ol all exlsting and <br />prcposed structurea on the �ot <br />• Ex;sting and proposed utilifies <br />• Centerline ol street <br />• Indicate Norlh <br />• Show any proposed grading changes <br />• Show measuremenis <br />FERMIT CONDITICNS <br />'.. All calls for Inspection shall be made 24 hrs. in aCvance • phone 259•8815. <br />�. All work shall be pertormed in accordance wilh ihis permit and current City of Everett Design antl Constructlon <br />Stendurds end Sper,iflcations. <br />3. Call Locetion Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />$#�!7C1�L___ ��-Pa-1tF�Ls '���� G�-�l <br />�1- `J ��l,Tr'� o� �`�t'C1P'� <br />' ���- /�in%8s <br />Approvetl lor Co rudion Date <br />� � 7 L Pi <br />FINAL IN ECTI N Date <br />Approved as Constructed <br />evere[t PUBLIC WORKS DEPAR7MENT <br />� 3200 CedarStreet <br />Everett. WA 98201 <br />Phone:259-8875 <br />�m-,e�•�ss <br />ACIWOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less Ihe Ciry ol Everett Irom any and all claims lor domages, costs. <br />ezpenses, or causes oi action ihat may arise because oi installation <br />and mainlenance ot the improvement or other righ4oFway use hereto <br />applied for and lurlher agrees to remove same upon notice from ihe <br />City and t�replace public property damaged ihereby. <br />S n�ture f AppliC'dnt � Date <br />RK AU ORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 YS F DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILI LY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 OAYS DURATION. <br />