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• / Applicatlon For ,r � <br />r PUBLIC WORKS�PERMIT <br />Print or Type Only <br />/yl�iQ�//•t/ .�F�PLo��' �o. �ox <br />Owner <br />Describe Proposed Work <br />Prolect Address (if known) <br />002 - <br />Zip <br />r� � 3�� <br />� <br />Puelic Wor1u V�rmM • <br />BIOp Dpl • <br />Vu01k WMu FM <br />Totsl Fe� � <br />Uu Appl Fee P�IA = <br />galanq Dw � ��- <br />�.Tya-000-i�-8si <br />�v.v 98'� 99 <br />28.3 —ZZ$' 9 <br />Mailing Addresa Giry up rnona i�;�c+0�6�3 <br />Attach four (4) copies of plans for proposed work • Oraw to scale end note the following as appl�able: <br />• Property Lines • Centerline of strnet , <br />• OC�ine and dl{n¢msions of all existing and • Indicate North <br />prd� sed siructures onthelot • Show any ptoposed grading changes <br />" • Exi�ng and proposed utilities • Show measu�ements - — <br />�� � DO NOT WHllt tltLUW Ihll: LIIVt ' / <br />I <br />r <br />> PERMITCONDITIONS�„ ,/ <br />1. All cells for inspectlon shell be mede 24 h�s. in edvance - phone 259�8810. <br />2. All wark shell be performed in accordence with this permit and current City of Everett Design and Construction <br />Standards and SpeciHcatlona <br />af= —�13. Call Lxation Underground Service 48 hra betore you dig• TOLL FREE NUMBER 1•800-4245555. <br />� ryj�x.,,,��„ hei9,� r�� �e.,ce sifa ll 6e f/z '• <br />J S.�or�L� fSe c'i�`,�v�r need_, fo o�a wor�E i� i+�;.r <br />4rea /� S�all'�.6e fLie ou�n�r v�as�onc..d.l,�/ �fo <br />h-ia✓e f�e +���e. <br />�. DO Naf 7L��GC /n <br />� <br />Gcla �er vrsefers. <br />�� �� 9//� <br />Approved for onstruction �a�e <br />I.IJC�'✓ ' � �/' •6 �/� �� � / L ��' <br />FINAL INSPECTION Date <br />Approved as Consiructed <br />����PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259•8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all ciaims for damages, costs, <br />expenses, oi causes of action that may arise necause af installetion <br />and maintenance of the improvement or other right•uf-way use hereto <br />applied for and further agrees lo remove same upon notice from the <br />City and a replace public rop ty damaged thereby. <br />f <br />� � -�-,/.� '�I�%�.t� !�s/�y <br />Signalure of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAVS OF DATE PERMIT IS �NSSUED AND THEREAF�ER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />•b <br />