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�; - <br />. .. : >r , .. _ . �"I1}i"i. , ' . ' S �� ; i� . . <br />Date_�� <br />Application For � � � <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />FoeM1c WorksParmit r `� �— /�� <br />e�aq. oeo�� � ���iG �—�aZ� <br />PubhcWo�ksFea S <br />TOIrIFee <br />Le55Ap0�Fee?aid $ <br />Balznce Due $ ' � � <br />, !�� <br />��G-c� �Air/I'L(//1 � 5! � — %7'I %i/�� .� -(� �i��/�,t9 ��(fo�(:�� �S .�S/ �L <br />Owner D'_,ing Address Cily Zip Phone <br />Mailing <br />Describe Proposed Work <br />Project Addre=s (if known) � 1rw 7/�l �7 � � � )� <br />Zip Phone <br />Atlach (our (4) copies ol planc (or proposed work - Draw to scale and note the tollowing as applicabl�: <br />• Property Lines • Centerline ot street <br />• Outline and dimen,ions of all existing and • Indica!e Norlh <br />proposed structures on the lot • Show any pronosed grading changes <br />• Existing and proposed utilities � Show measuremems <br />PERMIT CONDITIONS <br />1. All call; tor inspection shall be made �4 hrs. in advance - phone 259•881 5. <br />2, All work shall be performed in accordance with ihis permit and current City of Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•500-424-5555. <br />���PG !t/rSr L_i ,i � T ,fJl� �T' ,�: J C!t G1•Yr it 4�/�C�UTJ� <br />,T,us3-<t t c .� . <br />J� T/i5 L��iii.Di�../« i�;� iVoi T� � t�'�- �✓.S .=L, <br />, , _- .7 6'� : : .,. -- - ' <br />�� �' . . _ . <br />� �=� ::, ,,�" _ � <br />� Fcp�oved for Construction Date <br />FINAL INSPECTION Date <br />Approved as ConsVucted <br />everett PUBLIC WORKS DEPARTfdENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phone:259-9815 <br />W <br />� <br />i.f <br />� <br />� <br />O <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMEPJT OF CONDITIONS <br />The undersic�ned owner/apPlican� hereby agrees to hold and save harm- <br />less the City of Everett Irom any and all claims for damages, costs, <br />ezpenses. or causes ot action that may arise because of installation <br />and maintenance ol the improvement or other ri9ht�ol�way use hereto <br />applied tor and further a9rees Io remove same upon nolice Irom the <br />Cr.ty and tQ,replace public pro�rty damaged thereby. <br />� / ' � <br />/; ! , <br />-'i� � .�'� � ���, ;' - <br />li� � <br />' J -'/r":% <br />Signature of Applicanl �� Oate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND TH[REAFTER 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 />