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Date�Lp6 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� <br />vo V. �Yha.. <br />Describe Proposed Work , <br />�r � V <br />Project Address (il known) <br />0 � ,Su «�� /�re �u <br />iing Address City <br />fC� <br />City <br />Pvplic WorW Permit s r%�� ��G <br />pl0g. Oepi. • <br />PuEuc Wmks Fuo S <br />To1al Fea <br />Less ApP� Fee Paid $ _ <br />Balance Due <br />S �C� �)P <br />wf..ZJ i-Zl9/ <br />, Q/,Za 3 3Ss S�i � <br />Phone <br />Phone <br />� �.i.:.,P � o <br />Attach lour (4) copies ol plans lor proposed work - Draw to scale and note Ihe lollowing as applicable: <br />• Properry Lines • Cen�erline ol street <br />• Outline and dimensions ot all existing and • Indicate Norih <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measuremenis <br />PEFiMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance - phone 259-881 5. <br />2. All work shall be perlormed in accordance with Ihis permit and current Cily of Everetl Design and Consiruction <br />Standards and Specilications. <br />3. Call �ocation Undarground Service 48 hrs. bzfore you dig. TOLL FR�E NUMBER 1•800•424•55$5. <br />LL I/✓S7fft[ 'i�L�.LO.��. �6 � U�' /c`�-y C�fJi71C.C�'i E CGL!/E.�'7� <br />uiv�F,E D,�irEev�4f/ <br />/ <br />C�l�9t� •9�'/'or'EO f'F.�:= lif'.�.e� l,�/'r✓/`�,�Q �/�/5C <br />�" � ��� �/.��� <br />Approved for ConsiFuction ate <br />FI SPECTION r� �� p�L <br />Approved as Conslrucled / <br />everett PUBLIC WORKS DEPARTMENT ✓ <br />� 3200 Cedar Streel <br />Everett, WA 98201 <br />Phone: 259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />F- <br />� <br />� <br />u <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less Ihe City ot Everett Irom any and all claims lor damages. costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or olher right•of�way use hereto <br />applied tor�nd turih�eJ agrees to remove same upon notice from the <br />City i ep � Gbli perty damaged Ihereby. 9 <br />� ; � , 2!�/1� �� —oc�-p(�j <br />9 A. iN�.. ,�%—A/_ <br />QI <br />Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTFD 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 />