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� <br />� <br />TYPE OR PRINT ONL'f <br />Application for <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTM=NT <br />3200 Cedar Street <br />Everett, WA 98201 'S9-8810 <br />IiL <br />Date � n � ��/� • � �� <br />Public Works Permit N �`� � � `� ' — � <br />Building Permit # <br />Public Works Fee $ ��`� . � <br />,f.JJ i � <br />9R�vl �39'- � <br />�.. __ �e��r�� nddrNss City Zip rnone <br />Proposed Work <br />PROJECT ADDRESS (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following if applicable: <br />•Property L�nes `Outline and dimensions of all existing and proposed structures on the lot •Existing and proposed utilities <br />•Centerline of street •Indicate Norih •Show any propesed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-0810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you diy. TOLL FREE NUMBER 1-500-424-5555. <br />�� ��Z K'� r� � M -�,+1c� h e; c' �1 �- ; n-i��,e <br />5���1 nu+ pxce_ed 4.Z,� <br />S <br />� � b I,z. <br />j�( � n i w�u M se-� bz,c.K. -%�"� ..�c (c e�`� <br />s h�<< �. sf�:ks„k <br />�/��� �'� <br />Appr tl for C tr on Date <br />FINAL IhSPECTION Date <br />Approved as Constmcted <br />('� Jl�-�-a+-wa�l <br />p� S� �e�.�zll� <br />W <br />� <br />�♦^ <br />V♦ <br />� <br />� <br />� <br />� 09/25/9b 3=00F'M OOOAtt7866 <br />I / <br />q00Q96357 <br />OTHER <br />CHECY <br />�� <br />920.00 <br />320.00 <br />�/� <br />V♦ <br />� <br />a <br />�krR <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the C'ty ot Everett from any and all claims fur damages, costs, expenses, or <br />causes of action ihat may arise because of installation and maintenance of <br />the improvement or other right-of-way use hereto applied for and (urther agrees <br />�o remove same upon notice from ihe City an} �o replace public property <br />damaged thereby. �� �� <br />COMPLEi'ION.TIH S ERMHT MAY BE CANCELLED BYTHE CINIUPON ANY STOPPAGE OF WORKI ON THIS PROJEC O ER 90 DA S DULRATIONLY PURSUED TO <br />