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nate <br />• � ApPlication For <br />PUBLIC WORKS PERMIT <br />Print or Typ� Only <br />� <br />J <br />Mailing <br />Puph< WorYs Permit s _. <br />eme oeaL, <br />PnbucWorksFec s <br />tatal Fee <br />Less Appl Fee Pai� $ <br />� �alance Oue � <br />4 5 I�-� pl SW �v� 98203 <br />City Zip Phone <br />-�Sc• w�e - ��a ��a3 <br />qpplicant Mailing Address City Zip Fhone <br />Describe Proposed Work �1.__�__Q�-Q 1�n �h�-�` nf ��V�G,'�.P�� �,U�Vlr` � R I� <br />n .. 1�.\ 1.. _ . I .1 �. .� � <br />ProlectA�nown) �'w �QP- � �l{U�i s�s� �� <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the tullowing as applicable: <br />• Property Lines <br />• Outline and dimensions ot all existing and <br />proposed structures on ihe lot <br />• Existiny and proposed utilities <br />Approved tor <br />• Crnterline of sireet <br />• In,iicale Norih <br />• S iow any proposed grading changes <br />• Si�ow measurements <br />71.Y� <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phr. � 259-8810. <br />2. All work shall be pedormed in accordance with this permit eod current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. 6efore you dig. TOLL FREE NUMBER 1•800-424-5555. <br />���//� �, <br />; v <br />�%l/sT G=o %f/,� �'� ��rf/ �_S� 1'.r% <br />�i2s�T -- �-5�-� �i7��f/�/� <br />Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8810 <br />L� �iE,� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />The undersiyned owner/applicanl hereby agrees �o hold -and save harm- <br />less the City of Everett trom any and all claims tor damages, costs. <br />ezpenses, or causes of action that may arise b=cause of installation <br />and maintenance of lhe improvemeN �r other righl-ohway use hereto <br />applied for and further agrees to remove same upon no�ice from ihe <br />Ciry and to replace public property damaged thereby. <br />�,.�,�,� 1�. „_n,l� -�S� <br />Signature of A licant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARI'ED WITHIN <br />780 �AYS OF DATE PERMIT IS ISSUED AND THEREAF1cR IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERAIIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />