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oece.�lr�G <br />Application For <br />PUBLiC WORKS PERIUI�T <br />Print or Type Only <br />DAscribe Proposed Work <br />Project Address (if known) -��/G — <br />r�uuresa <br />���Y Zip <br />r+wress Gity Zip <br />� ! _ � —J�/�LLt�_•____�=b_ <br />! <br />�G i7" l�ft-�`�� �� <br />s� �' <br />_ � i _Si�i <br />Attach four (4) cop�es of plans for proposed work - Draw to scale and r�ote the following as applicable: <br />• Property Lines <br />• Outline and dimensions o( all existing and <br />proposed structures on the lot <br />� Existing and proposed utilities � <br />PERMIi CONDITIONS <br />PuElit WorM6 Ferm[�l.t �• G7Gi �� <br />Blap. DePI. s __Qy� /�Ie��C/ <br />__�. � <br />PUEIic Worka Fea <br />7otal Fea s _ <br />Lass AOv� Fee Paitl S__ <br />�� 00 <br />Balar cn Duo .S _ <br />• Centerline of street <br />• Indicate Worth <br />11 Show any proposed grading changes <br />• Show me �suremenls <br />Phone <br />1. All ��a!Is for inspection shall be made 24 hrs. i��. advance - phone 259-881 5. <br />2. F. nork shall be performed in accordance wi,h this permit and current City of Everett Design ana Construction <br />Standards and Spacificationa <br />3. Call Location Lnderground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />" ���'��3 = � - - i t��r� - � <br />_. � � �'7i-A <br />� • <br />.5- itiE�v L%'i6 �`i2i,9� %o ,BE' T.riS'��LG !-"U .�E.2 <br />CiTj STs>>vi�y2Q -b`�3c�7. <br />�� �-�,� � �fi' 6'� <br />Approved for nstruction Date <br />�� 7-?1 -il <br />FIN INSPECTION Uale <br />Approved as Constructed <br />evere[t PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259-8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agr�es to hold antl save h;rm- <br />less the City of Everatt (rom any and all claims for damages. costs, <br />expenses, or causes of action that may arise because ol installation <br />and maintenance uf the improvement or other righFobway use hereto <br />applied for and further agrees to remove same uper notice irom fhe <br />Gity an�ace lic property damaged thereby. <br />Signat�plicant r�—���— 1D teo <br />WQRK AUTHr?RIZED BY Th11S PERfAIT MUS7"B£=STARTED WITHIN <br />180 DAYS OF DATE PERM17 IS ISSUED AN!� T:�F��AFTER IS TO <br />BE DILIGEN"fLY PURSUED TO COMPLETICN. iHIS PERM1!IT �AAY BE <br />CP,NCELLED GY THE CITY UPON ANY STO'PAGi: OF N.'CRK ON 1 HIS <br />P! OJECT OVEH 90 D4YS DUfl�',TION. <br />