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Date lJ � B � <br />/ ' <br />AppliCation fof <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� <br />� <br />Uescribe Proposed Work <br />Projecl Address (if known) <br />v� <br />Mailing Address <br />r zai <br />Publs WorYs Permf, r � .37n <br />BIGj. Depl. a , <br />Public Works Fee 5 � <br />TolalFce <br />Less Appl Fer Pnitl S-- .�,�—�— �� <br />Balancc Oua $ _=z_� <br />(/ A g�r <br />�i1 /�F.(� f�G��l� ��.�.! % % Z— (p5/c{� <br />ity Zip Phone <br />ity Zip Phone <br />Attach four (4) copies of plans lor proposed work • Draw to scale and note the tollowing as applicable: <br />• Property Lines • Centerline of street <br />• Uutline and d�mensions of all existing and • Indicate North <br />proposed sUuctures on the lot • Show any proposed �reding changes <br />• Existing 2nd proposed utilities • Sho�v measuremenis <br />PERPAIT �ONDITIONS <br />t. P,II calls (or inspection shall be made 24 hrs. in advance - phone 259-881 5. <br />2. Ail work snall be pr.rformed in accordance with this permit and current Ciry ol Everett Desic�n and Consiruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FR�E NUMBER 1-800-424-5555. <br />c�ii�"Ce�n,�.0 T B� �e�a/.� /�=,�' /."i�<�,�'n��f-,o <br />; ���.,! D�'%-'t� �i i -- ,��; <br />`1 <br />LT'c�1�' <br />Approved for <br />1-- (9 (i�lJ O <br />FINAL INSPECTION y Date <br />Approved as ConsVucted � <br />evcrett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone:259�8815 <br />W <br />H <br />� <br />Z <br />�i <br />� <br />♦�^i <br />V♦ <br />� <br />a <br />ACKNOWLEDGE!�9ENT OF CONDITIONS <br />The undersi9ned owner/applicant hereby ac�rees lo hold and save harm• <br />less the Cily of Everett from any and all claims lor damages, costs, <br />expenses. or causes of action that may arise because of installation <br />and maiMenance of the impro�emenl or other righl�of-way use hereto <br />applied for and turther agreee to remJ�ve same upon notice from the <br />City and toyyQlace public pyopet4j� cJ�piage¢!ihereby.� <br />/ iv �i i <br />Signature of Applican� {L Dalu <br />b'vOf7K P.UTHORIZED BY THIS PEAMIT MU T BE STAFILD WITHIN <br />180 CAYS OF DATE ��EI7MIT IS ISSUED AND THEREAFTER IS TO <br />6E DILIGENTLY PURSVEC TO COMPLETION. THIS PERMIT MA1' BE <br />CANCELLEG BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />