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Date�g.�Ps <br />Application Fcr <br />PUBLIC WORKS PERMIT <br />Print or'fype Only <br />Publie WorkePermlt. V '�rv 7 � <br />BIOp. Dept.+t _ �S, �% <br />Public Wo�kf Fee <br />To�el Fet S <br />LessApplFeePaIC S. <br />�— <br />Balence Uue $ ��"� <br />3Yd 3G3S <br />�w��a� i mainng Naaress Giry �' Zip Phone � <br />So �, .� <br />Applicant Mailing Address City Zip Phone <br />Gasaibe Proposed Work <br />Project Address (if knu.�n) <br />Attech four (4) copies of plans for proposed work • Dra:: to scale and note tne following as applica6le: <br />� Property Lines <br />• Outllne and dimensions of all existing and <br />proposed structures nn tne lut <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />• Centerline ot street <br />• Indicate North <br />• Show any pr�posed grading changes <br />• Show measurements <br />1. All calls for inspec!+un shall be made 24 hrs. in adv: �ce • Phor.e 259-881 5. <br />2. All work shall be ps�rformed in accordance with this �ermit and current City of Everett Design and Construction <br />Sta�idards and Spec�Eicationa <br />3. Call Location Ur,deryround Service 48 hrs. before you dig. TOiL FREE NUMBER 1-$00•424•5555. <br />� SiOE //f/ti'!� ,Sc�r a/IG[' /?�L'%T 6E %i Ff <br />S, SEc.��,e �t 6v.a r�c Sr�i1� .uor s'iioki�/ Cc,c��orcy o�l <br />PLnT f'�a� - SF� ��r,acsi�� <br />G- .I.E'iL��td�y i�P,F��✓ /S' lo B�= 1N.5T.QCG f�.� C�� <br />ST`f.�.�c,�Os' - S'�.� A7T,a�'/fEO_ <br />/, .PES/DENld L S��ELJGG� lj�di.t/ T G'E LNSTdLGc� <br />��iG C/7� %<1N1i4.P1% +4��j/i�i G7E�.di.G' /lIUST /(�OJ' <br />8E- i,.isrw«�.v Ar v.e,�-F��sy — <br />_ �� ��" /� �� .� : <br />Approved fo Constructio�'����� ,_ ate <br />f_'/ /� <br />rll'-� 7- Z z -yc <br />, AL INSPECTION Date <br />�, Approved as Coiistructed <br />� everett PUBLIC WORKS DEPAF.TMEN'f <br />�� � 3200 Cedar Street <br />Everett, WA 9820'i <br />Phone: 259•8815 <br />ACKNOWLEDGEAIENT OF CONDITIONS <br />W <br />H <br />s <br />� <br />Z <br />O <br />♦�A <br />V♦ <br />O <br />a <br />Tiie undersigned owner/applicant .tiereby agrees tc hold and save harm- <br />less ihe Ciry of Everett from any and all claims for damages, costs, <br />expenses, or causes o( action that may aii;,e because ot installation <br />and maintenance of the improv�rt�ent or other right•ot-way use liereto <br />applied for and funher egiees to remove aame upon not`ce from the <br />Cily and to replace public property damaged ihereb�•. <br />A� � �� � <br />Si nature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUF_D AND THEREAFTER IS TO <br />8E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY ?F <br />CANCELLED BY THE CITY UPON A�1' STOPF'AGE OF WORK ON THI5 <br />PROJECT OVER 90 DAYS DURATION. <br />