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Date�s�� <br />Application Fo� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�m CU�15T. 351 y i.�l:� �C <br />Owner Mailing Ado.ess <br />City Z�P <br />87- /�� <br />PUGLr.wo�MaPerm�il� f��� <br />eiee. oeoi. • —i —1---�' <br />Vubl¢ Wada Poe S _ <br />Talal iae <br />Lesa ADO� Fee P01E a �O � <br />Balxnca �ae s <br />`��I en� MailinpAddress Gry 2ip Phone <br />Describe Proposed Work 1�8�--'�FK <br />Pro�ect Address (if known) 5�i9 - s <br />Attach lour (4) copies of plans lor proposed work • Draw to scale and note Ihe following as applicable: <br />� Proper�y Lines .• Centerline of sireel <br />• Outline and dimensions of all existing and • Indicale North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utililies • Show measurements <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs in advance • phone 259•881 5. <br />2. All work shall be performed ir. accordance wilh this permit and current City ot Everett Design and Construclion <br />Standards and Specilications <br />3. Call Location Underground Service 4B his. 6e!ore you dig. TOLL FREE NUMBER 1-500•424-5555. <br />ry_ �+LL L7.ei�'F�c/f�y PE2 CiTy OF EdE.CE rT �.do�.e0 <br />rf���� j �.�-dJ �E%1 .S�ECTia.✓ "� .3.3 7 � <br />����_ .�- � �� <br />Approved for Cons tion Date <br />7 <br />�� /� _1i-�Z_ <br />FINAL INSPECTIOh Date <br />hpproved as Construcled <br />everett PUBL�C WORKS DEPARTNENT <br />� 3200 Cedar Slreet <br />Everett, WA 98201 <br />Phone:259-881s <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />The undersigned owner/applicant hereby agrees lo hold and save harm- <br />less ihe City of Everett Irom any and all claims for damages, costa <br />expenses, or Causes ol action that may arise because ol installation <br />and maintenance of ihe improvement or other right-of-way use hereto <br />applied for and further agrees to remove sam� upon notice Irom the <br />Cily and to replace public properry d a ageo ihereby. <br />'�n.J .� (. i�,v� —�- �1� L�'`�"` � l"I u � <br />- --� ` � �� <br />Signature of Appl cant / 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 DILIGE�'TLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS �URATION. <br />