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7�a- <br />Application For <br />PUBLiC WORKS PERMIT <br />Print or Type Only <br />Adtlress <br />PUDIIe WOM Mrntl • ! �� � <br />BMp. Dapl. • <br />h01e Worb F�e <br />tou� F« � <br />Lau Aool F�a P�iG : <br />B�bnp Due i //� <br />o D 2-�2? S�o/8B 3/ <br />Phone <br />qpplicant Mailing Address City Zip Phone <br />Describe Proposed Work ���1�!4 ��� � x �� /]S' t� ��'� t�1C��T'�Q gAq � Si'OKAC� <br />� C c lt <br />- - — . _ . �-. _ .. _ _ .�.— c�.r cn/� - e^�..,_�_ � <br />Project Address (i1 known) <br />Attech lour (4) copies of plans for proposed work - Draw to scale and note the lollowing as applicable: <br />� Propeny Lines • Centerline of street <br />• Outline and dimensions ol all existing an� • indicate North <br />proposed struclures on Ihe lot • Show any proposed grading chenges <br />• Ezisting and proposed utilities 0 Show measurements <br />PERMIT CONDITIONS <br />1. All cells tor tnapection shall be mede 24 hrs. in edvence • phone $5�8810. <br />2. All work shall be pedormed in accordence wilh this permit end curtent City of EvereN DeaiBn and Conetructlon <br />Stentlards end Speclficalions. <br />3. Cell Locetion Underqround Service 48 hrs. before you dlg. TOLL FREE NUMBER 1•800-424�5555. <br />7. /j�2GP C/7`f/Sfi�ef's C(ea� af 4lL f;�»eS <br />����or�z— 7��{' i2 <br />Approved lor Consiruction � <br />/✓o U�2 ' �� u.�f �� 9 <br />FINAL INSPECTION D e <br />Approved as Constru ted <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259•8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby egrees to hold and save herm- <br />less the Cily ot Everett irom any and all ctaims for damages, costs, <br />ezpenses, or ceuses of action that may ariae because ot installation <br />and maintenance of the improvement or other righFof-way use hereto <br />epplied for end further agrees to remove same upon notice Irom the <br />City and to replace public propeAy demaged thereby. <br />/ �Q��r,,.. ��s�� �%.o-9x <br />Signatura of Applicant Dete <br />WORK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUtD AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITV UPON ANV STOPPAOE OF WORK ON TMIS <br />PROJECT OVER 90 DAYS DURATION. <br />3 <br />