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Date�V� <br />Application For <br />PUBi�IC WC)RlC� 1PERMIT <br />Print or rype C�nly <br />V <br />r <br />Public Wohs Pe� �a �/�✓ /��/��• <br />9ldg. Depl. � __ la� / ^ <br />Pu�lic Warhs Fee $ <br />iolal Fea <br />Less ApPI. Fan raia $ <br />9alante0ue $ �OOO <br />k� � — <br />Apolicant Maiiing Addres[. City Zip Phone <br />Describe Proposed Work _ v �� - — <br />�'�oject Address (i( know�i) <br />1— 5���.s <br />Attach four (4) copies of p!ans (or proposetl work - Draw to scale and nota th�e following as applicable: <br />• Property Lines <br />• Uutline and cimensions of all existing and <br />proposed stru.^.tures on thc iot <br />� Existing and proposed utilities <br />: <br />IE'CrJ- "'r� <br />• Centerline ot slreet <br />• Indicat� North <br />• Show any proposed gradin5 changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All ;alls for inspection shall be made 24 hrs. in advance • phone 259•881 5. <br />2. All v�ork shali be performed in accordance wiNi this permit and current Ciry of Everett Design and Construction <br />StanCards and 5� �acificatiuns. <br />3. Call Locatioii Underground Service 48 hrs. before you dig. TOLL FREE NUMBER �-$00•424-5555. <br />y�i ��%r � �—'4 �j <br />�j�, iPE�o v�' .9tiD ,PEP.0 9c� ACG E,ri-sT'�.��r Cu.e 8� G-Ur/E2 <br />f7N!'U �1yvE/�/i�.�.� ALo�/G- P.AGt�'ErTf/ F�pr1T/�G{ �"R. J'ECTio.V <br />3 3, � �f ��E �UdLiG WO�,f� �"TFi.�D9.c'OS . <br />.S, <br />.%�i�f�L /G9�/T /�7/_,,cST Sc'{!ED/JAG /n�.�ETiNd Wiry Tfi�E C�!� <br />��d��c !r>i�2:ts T•✓S�rTa2 i�•e.o.e Td Sr�9•�%%u� «/O,e,e, <br />��� ��= i�� <br />Approved for C s tion a�e <br />/ ' �_� l�� ���� <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everetl, WA 98201 <br />Phone:259-8875 <br />ACKN0�I�LEDGEMENT OF CONDITIONS <br />� <br />w <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other righl-of-way use hereto <br />applied for and further a�rees to remcve same upon nolice from the . <br />City and to replace public pro jfty c'amaged thereby. �� <br />'/ � / ) � <br />� � � <br />% G� _C:,v� � <br />Si ature of cant � Date <br />WORK AUTHORIZED BY THIS E IT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS SUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER S)0 DAYS DURATION. <br />