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Date� <br />Appliwtion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />C� �uP ho� OU <br />Owner <br />-X1 YY� 'Q' <br />Applicant <br />Describe Proposed Wor1. <br />pAailing <br />yN <br />Atltlr255 <br />l:iry <br />Prolect Address (il known) 7/'s �— y��� �T <br />i <br />Attach four (4) copies of plans lor proposed work - Draw to scale and note ihe lollowing as applicable: <br />• ProFerty Lines <br />• Outlin? and dimensions ol all exis�ing and <br />proposed siruclwes on ihe lot <br />• Existing and proposed utilities <br />Pu�Lc Wmks Pen -• ` !�,`�p _ /�S <br />Bmq Deoi. + �J1(�? <br />Pultl�c Wo�ka Feo <br />Total Fee s <br />Ll59 Appl F<C PTiO $ � <br />Balance D�o $ � �`� <br />• Centerl:ne of streel <br />• Intlicate Norih <br />• Show any proposed grading changes <br />� Show measuremeNs <br />rnone <br />PERMIT CONDITIONS <br />1. All calls for inspectlon shall be made 24 hrs. in advance • phone 259-8810. <br />2. All work shell be performed in accordance with ihis permil and current Cily of Everet� Design and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•S00•424•5555. <br />� 6������ � � �U°�,��,,,�� ��� <br />• <br />—�}Q�/1 ���" �, a�z Y� �/�5 <br />APProv�.�l lo/r�,ay lr"r�—q� utlion � <br />�/j rT�TD�7 <br />FINAL INS 10 / / aa �e <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT � <br />� 3200CedarStreet <br />Everett WA 98207 <br />Phone: 259-8810 <br />ACKNC vL[DGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />I•1 <br />u <br />� <br />� <br />� <br />a <br />The undersigned ownc•��,pplicant hereby agrees to hold and save harm� <br />less Ihe City ot Ev� iett �rom any and all claims tor damages, costs, <br />enpenses. or causr.� ol action that may arise because ot installation <br />and mainlenance o� the imp�ovement or other righbof�way use hereto <br />applied lor and lu �er agrees to remove same upon notice Irom Ihe <br />Ci�y and to repl�pub�ic prop�rty damaged �hereby. <br />CNORK AUTIiORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />iB0 DAYS OF DATE PERMIT IS ISSU[D AND THERE�FTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 9E <br />CANCELLED BY THE GT'� UPON ANY STOPPAGE OF 1NORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />