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Date y/r —r,� � <br />qpplication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />a�-- 9° <br />PubLc Wo��e Permit t <br />a�ao oso� . �`r / r <br />CoGi�cWoiMefee S <br />To1el Fee <br />�ese noo�. �ee PuE S �— <br />Beisnce0�e s LD �� <br />Mailing <br />Describe Proposed Work <br />prolect Adtlress (il kno�vn) ��� � <br />Atlach tour iC; copies of Plans for proposed work <br />ciry �,,, <br />Draw �o sca�e and note ihe following as app�icable: <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />proposed structures on ihe lot <br />• Existing and proposed utilities <br />• Cenir.rline ot street <br />• Indicale North <br />• Show any proposed grading changes <br />• Show measureme��s <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 2d hrs. in advance - phone 259•881 5. <br />2. All work shall be pertormed in accordance wdh this perm0 and current City of Everett Design and Construclion <br />Stantlards end Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•42�:•555 . <br />� <br />� <br />FINAL INsri <br />�pproved as <br />everett <br />e <br />�CEQ/'— yd.fl� <br />AT LCa ST <br />�nstructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 98201 <br />Phone:259�8815 <br />�CT BGC�C <br />r � <br />;_,2 5'-� <br />i �7 � ST B� <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The unders�gned owner/applicanl hereby agrees to hold and save harm� <br />less Ihe Ciry of C-verett Irom any and all claims lor damages, �.osts, <br />¢xpenses, or causes of acGon thal may arise because ol installation <br />and m�intenance ol the improvemeN or other nght�o4wey use hereto <br />applied lor and lurther agrees to renove same upon nolice Irom ihe <br />City antl to replace Dublic proDerry damaged thereby. � <br />�i , <br />/ �/' ; � / yv <br />� <br />ate <br />ignaWre ol APp i nt <br />WORK AUTHORIZED BY THIS PERMI MUST BE START[D WITfiIN <br />180 DAYS OF DATE PERMIT IS ISS�UED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY OE <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />z <br />0 <br />—i <br />�--i <br />n <br />m <br />n.. r. <br />1 T <br />..� <br />�' m <br />0 <br />co <br />mo <br />--i c <br />om <br />_ -�i <br />m <br />.o z <br />> �--I <br />r x <br />1 N <br /><T <br />oa <br />T1 D <br />�m <br />m� <br />� <br />O � <br />C (/� <br />3 N <br />r*� <br />.im <br />a <br />� <br />-� <br />_ <br />a <br />z <br />—� <br />� <br />� <br />� <br />� <br />� <br />� <br />� <br />