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Date�O i <br />.4pplication For <br />PUB�IC WORKS PERMI'' <br />Prinl or Type Only <br />PuDlic Wo�ks PcQrmll a <br />Bltlg. Dept. s _j,]_ ���__ <br />Public Works Fec <br />TOlal Fce g <br />Less Appl. Fee Paid S <br />fialance Due $ <br />� � �(� <br />��� � i. -6L -- <br />Applicant M..iling Address City Zip Phone <br />Describe Proposed Work .���� -Fo�N�ar� r�t, ) __ <br />Project Address (if known) /OOJ ` jJ ts S� <br />Attach four (4) capies of plans for proposed work - Draw to scale and note the lollowing as applica6le: <br />• Property l'�es • Centerline of street <br />• OuUine and dimensions o( al1 existiny and • Indicate North <br />F�roposed structures on the lot • Show any proposed grading changes <br />• E;isting and proposed utililies • Show meaeuremenis <br />PERMIT CONDITIONS <br />1. Atl calls for inspection shall be made 24 hrs. in advance • phone 259-8E1 5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424�5555. <br />h?�y ,"�; � � .�..���:-� �- �:« ��,�.�,�.�,T <br />/i/ .L�,�o�,�J Ti/�s /�ovst lc�-�c .r'EC�c.;;t� <br />�VD.T�n�.�gG .E'��dc.e �v2e:�s DE�T �f-7�/z>:,�`'C- <br />��//�-i G � Z �f L7' � <br />�� = �/==� <br />i�pp;oved for Cons c ' �a�e <br />� ��' � ��-�� <br />FINAL IIJSPECTION Date <br />Approved as Conslructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everett, WA 98207 <br />Phone:259-8815 <br />�� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />■ <br />� <br />� <br />� <br />O <br />a <br />The undersi�ned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett frcm any and all claims lor damages, cosis, <br />expenses, or causes of action that may arise because of installation <br />and maintenance ot the improvement or other right-of-way use nereto <br />applied for and further agrees lo remove same upon notice from lhe <br />City and to repl q public properry damac�ed thereby. <br />i' J � ��3��� <br />6 <br />SignaWreo(Applicant � Date <br />WORK AUTHORIZED DY TFIIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT .'i ISSUED AND �iHEREAFTER IS TO <br />B[ DILIGENTLY PURSUED TU ::OMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVGR 90 DAYS GURATIGN. <br />