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Date �� � <br />gpplicatioti For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />yz'_ <br />Describe Proposed Work <br />City <br />85-zz9 <br />Public Worke Permit • -� <br />Bldg. DePt s <br />Public Wo -__ <br />Total Fee <br />Less APPt Fee Paid $ c a <br />B818OCe Due <br />Ca t[ p <br />DL .5— <br />Zip Phone <br />Project Address (it known) following as applicable: <br />Attach four (4) copies of plans for proposed work -Draw to scale and note 9 Centerline of street <br />• Properly Lines • Indicate North <br />• Outline and dimensions of all existing and a Show any proposed grading changes <br />proposed structures on the lot a Show measurements <br />• Existing and proposed utilities �� <br />GI nw THIS LItJE <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.881 <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. TOLL FREE NUMBER 1.800.424-5555. <br />3. Call Location Underground Service 48 hrs. before you dig. <br />T TyfI .PErnO//E ,q,r/D .�E�L.46E TilE `�•vG� /.t/ TilE <br />�ieTE,c^' �Q/.r/ ry,2ou�sfl s AP� <br />EdEN'' T, <br />yE� Gydr� Lr�/� fEsz/GC rJ'ivST BE PL4GE� <br />s 4mE Gocd riot AS ' / <br />AT TrlE e,e �v eT�/F e �'Qc,C A�Q <br />Vpor_ X. <br />Approved for Consiruaml, / <br />��7 /r'1_l <br />uate <br />—nN INSPEGTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />vCedar Street <br />Everett WA 98201 <br />Phone: 259.8815 <br />Ch <br />m <br />0 <br />Z <br />O^ <br />on <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all cla::ms for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />emove same upo <br />citylland to replacepublic propertyrdamaged herebyn notice from the <br />Date <br />Signature of Applicant <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />SUED <br />JBO DAYS OF BE DIILIGENTLYREAFTER IS TO <br />DATE PERMIT PURSUED TOIS IS COMPLETION.OTHIS EPERMIT MAY IS <br />CANCELLED BY THE CITY PROJECT OVER 90 DAYS DURATION. <br />ANY <br />STOPPAGE OF WORK ON THIS <br />z <br />O <br />m <br />