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Date�.�'j <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Malnng <br />cv � <br />Describe Propoaed Work —! �S �l /� <br />Project Address (if known) <br />� S� � <br />Zip <br />Attach four (4) copies ot plans for propc^ed work • Graw to scale and note tha following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structu ss on the lot <br />• Existing and proposed utilities <br />PERMITCONDITIONS <br />PubllcwoAePermit•!�/� %�p <br />Bldp. Oept • . �� <br />PuOIIc Works Fea a <br />Totel Fae <br />Le9e AppL Fae PeIC S �f� <br />Belence Dua S f'�/�O <br />• Centerline of sLeet <br />• Indicate North <br />• Show any propose�'grading �hangas <br />� Show measurements <br />3 y7 - 736.� <br />rnono <br />1. All calls lor inspectlon shall be made 24 hrs. in ad��an.;e - phone 259•8815. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications <br />3. Cali Locatiun Underground Service 48 hr;. before you dig. TOLL FREE NUMBER 1•800•424•s535. <br />i� �.�o,ve y,q,eo sEi- B,�rc,e ro �� <br />Uf� a5 � L'.eor� P.�ci�E.eT� G,%NE_ <br />/ <br />�.4�/vl/ ��0�.� S-7 f�s <br />Approved for struction Date <br />✓ "� j�M�� % Z 2 -�l. <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Evorett WA 98201 <br />Phane: 259-8815 <br />A lyliN/M!/i�1 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />r <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned cwner/applicant hareby agrees to hold and save harm- <br />less ihe City of Everett from any and all ciaims for damages, costs, <br />expenses, or causes of action ih3t may arise because of installation <br />and maintenance of the improv nt or othyr right•of•way us hereto <br />a ed for nd further agree to ramove same upon n ic from the <br />ity and to r place public pr pe y damaged thereby. <br />� • ' � .S CS.S / <br />Sig ure of pplicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUS B STARTED WITHiN <br />180 DAYS OF DATE PERMIT IS ISSUE� AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CAPJCELLEC BY THE CITY l'PUN P.NY STOPPAGE OF WORK ON THIS <br />PRO.IECT OVER 90 DAYS C'URATION. <br />