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� , <br />41��) � � . <br />TYPE OFi PRINT ONLY <br />Application For <br />PUBLIC WORKS PERMIT <br />L�� r�rl <br />PUBLIC WORKS �EPARTMENT <br />� 3200 Cedar Sireet <br />Everett. WA 98207 259-8810 <br />Mailing <br />ND S'T <br />/ <br />Date � ' ��. � � !' <br />Public Works Permit p� s� <br />Building Permit # — <br />Public Works Fee $ _ <br />dd � _ <br />aK <br />r8zd� Zs7-yy� q <br />Zip Phone <br />�M �- � <br />Applicant Mailing Address City Zip Phone r <br />Describe Proposed Work <br />PROJECT ADDRESS (if known) <br />Atlach four (4) copies of plans for proposed work - Draw to scale and note the tollowing if applicable: <br />•Property Lines 'Outline and dimensions ot all existing and proposed structures on the lot •Existing and proposed utilities <br />•Centerline of street •Indicate North •Show any proposed grading changes •Show measuremenls <br />PERMIT CONC"TIONS: <br />1. All calls for in, , tion shall be made 24 hours in advance - phone 259-8810. <br />2. All work siiall b� rarformed 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 1-800-424-5555. <br />¢ ��uc..,�,�vfdz c�f ar4'' aL�n,� �/e <br />Cori,¢v- 4S .S�io��h :�h 7�c c��/¢cl�,/G/r,Qc.:irr� <br />'�• .Zt`'��ie Ci{� t',l�r /�teo%i �O �S� �+is ni9bf-Gf-Gia/ <br />f%iGh �iK vwna.- es�+ G✓iLC be ✓+�s'vo��c.GCr �r <br />inavinS �nC,e• <br />W' <br />� <br />� <br />V♦ <br />� <br />O <br />� <br />� <br />O <br />��/� <br />V♦ <br />� <br />a <br />0'/'_�!9G 4.5'F'Ff CCOR�!i9�� ; : `-� <br />!#00096^c59 <br />1� OTHEF. i�0.00 <br />� �ASH $�O.OD <br />ACKN06'JLEDGEMENT OF CONDITIONS <br />The undersigrted owner/applican� hereby agrees to hold and save harmless <br />���/� 7� /�6 ihe City of Everett Irorn any and all claims for damages, cosis, expenses, or <br />Ofi��'i /� causes oF action that may arise because of installation and maint=nance ot <br />ApprovedforC nst tion � a1e theimprovementorotherright-of-wayuseheretoappliedforantlfuNneragrees <br />lo remove same upon notice from the City and to replace paulic property <br />- f,��- �_ Z 2 L� l damaged ihereby. <br />FINAL INSPECTION Date 1 //�� <br />Approved as Constructed / �� � 7' %��- Y(�� <br />6 <br />Signa ure ot Applicant Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMI\ IS ISSUED AND THEREAFfER IS TO BE DILIGENTLY PURSUED TO <br />COMPLE710N. THIS PERMIT MAY BE CANCELLED BY THE CIl Y UPON ANY STOPPAGE OF WORK ON THIS PROJ[CT OVER 90 DNYo DURATION. <br />