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Date % 'J A -E7 <br />Application r For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing <br />ng Address <br />Public WOMB Permit 9 (; <br />Bide. Dept a <br />Public Works Fee S <br />Total Fee <br />Lea. Appt Fee Paid S <br />Belance Ova 5 <br />:1R-LF <br />Describe Proposed Work f ellc(n i f , p UP Meat - CJt-k r . C. lr / S fo,, u)! f / r iP (O , <br />Project Address (if known) _ _ <br />Attach four (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 259.881 5. <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 />/y/BL✓G LIJv.�.CS-" ��/YJii NGT �E-�(//.2E..O �,/�/Z —A% <br />/`Li9tii✓�/lr aEPA¢T/r/E.t/T AqW A-74"S7 17E7€2Mi t/f ff/�oFv <br />Ti/E � ^?�SrevLTivn.' o><- T//F r�9�•v P�AtiWfr LOT <br />L�/OUL.� /2c=gv�2F f9 SE04- /PE✓•Er✓ LFiISEPIiBL1L <br />�a /�POCiGgr/T <-d/GG -� •f'E�1r✓ieEv Tu <br />�a(c/. f�F<n/F GISE� FnE 7or/i�lrCooE ACKNOWLEDGEMENT OF CONDITIONS <br />Approved for Construction <br />FINAL INSPECTION <br />Appluved As Consliucted <br />everett PUBLIC WORKS DE <br />3200 Ceoz r Street <br />Evs: eft, Nr k 98201 <br />Phone : E g-8815 <br />W <br />O <br />O <br />a <br />The undersigned 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-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />.CLmeluie of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED 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 />