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TYPE OR PRINT ON�.Y <br />Apphcation For <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everelt, WA 98201 (425) 257-8810 <br />�,?R U 9 200i <br />� 7 POSTI^JG <br />i <br />Date PJ�3 �_� � <br />Public Works Permit M�_�4 � <br />Building Permit M L91nOY - O/ oZ, <br />Public Works Fee $ N /C _ <br />1,11�ry1 KG�IP�' 2218 SI�t2 SE�zc� �P.�Y�'ihki 98201 4L5-L5�-3Z75 <br />Owncr Mailing ACdress City Zip Phone <br />Applicant MailingAddress City Zip Phone <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) 22 ( 8 <br />Attach four �4) copies plans lor proposed work - Draw to scale and note the lollowing if applicable: <br />• Property Lincs • Outline and dimensions ol all ezisting and proposed stmctures on the lot • Ezisti�g and pmpesed ulilitics <br />• Centedine ot street • Indicate Norih • Show any pmposed gratliny changes • Show moasurements <br />DO NOT WRITE BELOW TIiIS LINE <br />PEflMIT CONDITIONS: <br />1. AII calls for inspeclion shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be performed in accordance with ihis permil and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLI. FREE NUMBER 1-800-424-5555. <br />���!�i„� ���•� „�t;•� [',��pi�i Voi (' ���tl!r:•�I <br />itc oi' I.� �rel� r: cords mdicate that Ihr u_ �i ��;n:u:� ���II hr loc:uc�l oc,•r Ihr eai�,liue <br />i�i..r��:�r. i1u� �icl::;�cri uwsl b� eitl���r llRelnc:ded uut Gmn und��r tlic c.us�e:• a <br />il peradod in malcrial to tua�t Ihr 1lPt'. <br />�ver 11�eration P;�nuh Required. <br />�'�� �r�� nni�t h;ive eut�er� .� dmtins��outti �md Ihe rc�otlop nmolTmus! be tietiUined lo �hc :id. <br />,„ <br />,,�,��li-��in� :i��kn„���L�rin:•t �I�r�,� �nn�iitinn' h�� ��i�ninc brlm�• <br />�(,�,�Q 'iE'� �'�z 8�23 ��r9 <br />pprove or ons ion a e <br />� <br />/ <br />� �..y�� �—SU-U( <br />FINAL INSPECTION Date <br />Approved as Consiructed <br />W <br />� <br />� <br />Y/ <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownedappliwnt hereby agrees to hold and save hartnless <br />the Ciry of Everett Irom any and all claims for damages, costs, eKpenses. or <br />causes ot action Mat may arise because of installa6on and maintenance ol the <br />improvement or other nght-ot�way use hereto applied for and further agrees to <br />remove same upon notice from Me City and to replace public property dam- <br />�aged hereby. <br />�• P� ./' /�� 8/30/9� <br />WORK AUT}iORIZED BY THIS PERMR MUST BE STARTED W11HIN 180 DAYS OF DAlE PERMR IS ISSUED IWD 7}iEREAFfER IS TO BE DILIGENTLY PURSUED TD <br />CDMPLETION. hilS PERMfT MAV BE CANCELLED BY iHE CIN UPON /J.'Y S7UPP.IGE OF NKNiI( ON THIS PHQECT OVER 90 �AYS WRATION. <br />