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Date1L-_L- � <br />, <br />� ��_; <br />� ,;�- .� � <br />Application For <br />PUQLIC WORKS PERMIT <br />Print or Type Only <br />�'��.� .� t�".� .� <br />Owner <br />f. l ( 1 <br />Applicant <br />Descri6e �roposed Work <br />Pro�ect Address �il known) <br />, <br />':� � i� � �.�:�����,��. <br />Mailiny Address <br />Mailing Address <br />-',� — � �"��._ <br />��o- s��s� sr� <br />Ci�y <br />ity <br />�� Z�Z J I <br />Fl�blif.4'�O�FS P1!fT�i v <br />oinn oeni.. ��'� ra_`1-,��-�_�j .1- <br />Pubhc Ylo�Fs Fee <br />Totai Fee 5 _ . ' <br />I <br />less Anni Fee Paio S_ _ <br />�U <br />Ealnnce Duc S �d <br />Attach lour (4) cepies of plans for proposr.d work - Draw lo scnle and note Ihe tullowmg as appli zhle: <br />• Property Lines • Centerfne ol street <br />• Outlme and dimensions of all exisimy antl • Indica�e North <br />proposetl siructures on ihe lot • Show any proposed grading changes <br />• Existing and p�oposed utiliti2s • Show measure.nents <br />FINAL INSPI <br />Approved as <br />evemtt� <br />e <br />C ' <br />�,-> <br />Piione <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 F.rs. in advance - phone 259•8810. <br />2. All work shall be peAormed in accordance with this r,ermit aad currenl Ciry of Everetl Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Undergrounc. Service 48 hrs. cefore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />(�c��C�:l.�;�:� �-. �.�� :- t�C �,. _: 4 rt-� .1� ��=,f, <br />�z����<<,, t � c- .z< -,�Y . <br />_ -i <br />,.�/ i .� ✓ <br />onstructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cetlar Street <br />Everett WA 9R201 <br />Phone:259�8810 <br />e <br />� <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOVJLEDGEMENT OF CONDITIONS <br />The under5�9ned owner/applicant hereUy agrees to hold anC save harm- <br />less the Cily ol Everett fro�r. any and all claims for dai��..ges. cosis, <br />expenses. or ca�ses o� action ihat may arise because nt installation <br />and maintenance of the improvemenl or other right-of-way use h�reto <br />applicd for and further agrees to remo�e same upon notice from ;he <br />Gty and �o replace Dubhc prOpe��y c�am�,ga�d Ihereby. � / <br />� <br />$ignature ol Applicanl � 0 U�te <br />WORK AUTHORIZED BY THIS PERMIT MUST B ST RTED WITHIN <br />iBu DAYS OF DATE PERMIT IS ISSUED AND HEREAFTER IS TO <br />BE DI�IGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />C�NCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />�ROJECT OVER 90 DAYS DURATION. <br />