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Date��.l v-/ <br />AnPlicatien For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />K �I <br />Apphcan� <br />�� <br />ng Atldress <br />Mailinc� <br />Describe Proposed Work ��� � )�� <br />Proiect Address (il knawn� <br />z�, <br />y c�n <br />�� <br />P„„�,: wo,,, P�, � 8�� �—��rS r <br />Fi�i�� De�t.. ���c�_i��� <br />PuUi¢ 1Yor�s Fec <br />ioial Fre $ — --- <br />LessAn0lFcePai�� �J/- — <br />�nitn�e0ti� .S /—ll� <br />Attach four In) copies ot plans lor proposed wo�k � D�aw lo scale and note the lollowmg as applicable: <br />• Property Lines • Centerllne of streel <br />• Outlme and dimensions of all eareting and • Indicale Norih <br />proposetl structures on Ihe loi • Show . ny proposed grading chang�s <br />• Exisling anJ G'onosed Wiltlies O Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shail be peAormed in accordance with this permit and current City ol Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underqround Service 48 hrs. belore you dig. TOLL FREE NUMBER 1-800•424•5555. <br />/�. (,��g,E,�,'�C��z. At�+p `��ixt,tnu� AC�c,�„ `r��t�r►�C� cF <br />r��LC�PC-lzT`i� I�� i!v (= XGL"LL-(-7�T� C�N l7 �l-l�i:�l W � i�i NQ <br />F'�'�e71� — AN�; j�AYtAEiE Sr1Al_L. �C- RcC'�-r��c_i� C3�' TNL- <br />A P Pu c-Pav'C', <br />5. �CC�F DC /�lni`� SkIALI. t� 'T1Eili"r L I�i�T� -f�l � 11%�-_ �,c I.��,. <br />�rr, cs S, 1�� �%QC � 2-' 1t '` <br />Approved lor Construdion D, le <br />/ <br />�a���/_.. �— /—i'�' <br />FINAL INSPECTION Date <br />Approved as ConsVucled <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phone:259�8810 <br />W <br />H <br />� <br />� <br />� <br />O <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersic�ned owner/applicant hereby agrees to hold and save harm- <br />less Ihe Cily of Everett Irom any and all claims tor damages, costs. <br />expenses, or causes of action that may arise because of installation <br />and maintenance of ihe nnprovement or other �ight-obway use hereto <br />applied for and furiher agrees lo remove same upon nolice hom the <br />City and to replace public properry damaged thereby. <br />� Y9 <br />i ature ol Applicant Date <br />. RK AUTHORI2ED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEF7EAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PCRMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />