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Date��� 0 {i <br />Application For <br />PUBLIC WORKS PERNilT <br />Print or Type Only <br />Maili <br />�� <br />Zip <br />PUGIic WD�k9 ?e�mi� /s- �• � � /"'7" <br />910g. oe0t. a_� I/] /�� � oC <br />Public Works Fee <br />Toial Fee S <br />Less Ao�l Fee Peia S <br />�- <br />Baiance o�e S Z�� <br />A�� <br />qpp icant Mailing Address Ciry Zip Phone <br />Project Address (if known) <br />ib�- .�i SY s��. s.��/ <br />Attach four (4) copies of plans for p�oposed work - Drew to scale and note the follo�.ving as applicable: <br />• Property Lines • Centerline of street <br />� Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show �ny proNosed grading r,hanges <br />• E,cisting and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for insGection shall be made 24 hrs. in advance - phone 259•�•981 5. <br />2. All work shall be performed in accordance with this permit and wrrent City of Everett Dasign and Conatruction <br />Standards and Specifications. <br />3. Cell Location Underground Service 48 hrs. belore yo� dig. 70LL FREE NUMBER 1-300-424-5555. <br />�i� ��-�� y/-�/�6 <br />Approved lor C nsiruction % � <br />� � _ i��� �—��-� <br />FIN INSPECTION Oate <br />Approved as Consiructed <br />everett PUBLIC WORKS DEPAF"i MENT <br />� 32�0 Cedar Street <br />Everett, WA 98201 <br />F�hone: 259�8815 <br />ACKNCWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant he�eby agrees to hold and save harm• <br />less the City ot Everett from any and all claims For damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance ol ihe improvement or other right-obway use hereto <br />applieG for and furiher agrees to remove same upon notice irom ihe <br />City and}q replace oublic property damaged ihereby. <br />•-=—/"(.c-�JGI-�( ��/ (. -l/"f7/t'>� <br />3ignature of Applicant Date <br />WURK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERM'i IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED "�� �OMPLETION. THIS PERMI7 MAY BE <br />CANCELLED BYTHE CITY ��.�P�F; ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS bURAI'ION. <br />