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Date_� r �� <br />, <br />�'"`' <br />i �'� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />k N <br />Applicant <br />Describe Proposed Work <br />. �_� ZA"5':>, .. - . <br />�� <br />PUELc WOM� Permfl • ,� <br />Blep. Oept � � <br />. . ., .., n•�;: r: <br />TO POSTING n--`�,= <br />Address <br />0 <br />Zip <br />vuerc wark. iee <br />Tolal Fee s — <br />�esa Appl Fee PaiC s _—_ <br />Bslence Dve s � <br />� Proleot Address lif knownl � '� � � �� � — - — <br />AttBch four (4) copies of plana for proposed work • Draw to scale and note the folWwing as applicable: <br />. � . •�Property Linea • Centorline of street <br />��� �� Outline and dimensions of all existing and • Indicete NoAh <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilitiea • Show measuraments <br />PERMIT CONDI?IONS <br />1. All celle tor inspection shall be made 24 hrs. in advance • phone 259-8810. <br />2. All worlc ahell be peAormed in eccordAnce with this permit end curre�l �Ity of Everett Desipn entl Construction <br />Standerde and Specil!cetlona <br />3. Call Locetlon Underpround Service 48 hrs before you dig. TOLL FREE NUMBER 1-80o-4245555. <br />� . � �PI i ccw-v� 61 r�.L{ � �c,«.�.-,c- �, v. (a�-v-�. ; �'� �� l I � �a..br �� <br />� s-�- °�'- ew, a.."a...,� a, s�-aw� �-a� �-�- G{� �. b l�,c, <br />u,9+r k� ( � � g�- �-wr. <br />//.:/�� <br />' -�i�Q W� ��. � � 8 �`� - <br />Approved for Cons!ruction Date <br />F�NAL INSPECTION <br />Approved as Construcled <br />everett PUBLIr,\VORKSDEPARTM�NT <br />� 3200 Ceder Street <br />Everett, WA p8201 <br />Phone: 259•8810 <br />Date <br />� <br />� <br />ACKNOWLLfiGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby a9rees to hold and seve harm• <br />less the City ot E�.erett from any and all claims for dameges, costs, <br />eapenses, or cai��, s ol action that may arise because of inslaltation <br />and maintenzncr oi the improvement or other right-of•way use hereto <br />app�ied tor and iurther agrees to remove same upon notice from the <br />City d to replace public erty amaged thereby. <br />��,�,� " ,_ � <br />Signalure ot 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 DILIGENTL PURSUED TO COMPlE710N. THIS PER\1i1' MAV BE <br />CANCELLED BY THE GTY UPON ANY STOPPAGE OF WOPK ON THIS <br />PROJECT OVER 90 Dl.YS DCRATION. <br />