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/ <br />/ / %�l ���`�' / <br />Date� '� w}�II <br />� � Application For <br />PUBLiC °JVORKS PERn!�IT <br />Print or Type Only <br />��I r -, i�l � �� <br />�i � �r i � � � �'� � � � �� I .�_ f' <br />wner Mailing Address <br />� ��� � � �1� I � � � � �. _. � __�. t"�".) � '� iL- <br />� Applicant Mailing Address <br />�F.j PubLc\YmMSPmmiln _I <br />�Itl9. DePt u �_�) � ! ?C ( '"__—_ <br />T <br />Poblic Works Feo S � <br />romlFea <br />Less �O�I. Fea Paid $ _— <br />Dalanco Due 5 <br />L' � , � "), f�_r r, . <br />Ciry Zip <br />,i <br />. f, � -�- � ,, i �` _.. ' <br />City Zip <br />�s;'� „� ��; - -71=,x,-, <br />� <br />Phone <br />f � :,� - � � i, �..��_� <br />Phone <br />Describe Proposed Work j� Y' <<`. �� � �� 1� ���.'�� ' e� . <br />� i: <br />Prolect Address (if known) <br />Attach four (4) copies of plans tor proposed work - Draw to scale and note lhe lollowing as apPlicable: <br />! Properry Lines .• Centerline of street <br />o Outline and dimensions ol all existiny and • Indicate Nortn <br />proposed struclures on the lot • Show any proposed 9rading changes <br />• Existing and proposed utilities • Show mea;uremEnts <br />PERM� - CONDITIONS <br />t. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and cu« ent City or Everett Uesiyn and Construction <br />Standards and Specilications. <br />3. Call �ocation Underground Service 4F3 hrs. before you diy. TOLL FREE NUMBER 1-II00-42�-�555. <br />��'I: ��. � ! i �i� �� � <br />' I I i ( � . '� � � 1 I � • i . . i ' .�� � . i . ' i <br />i <br />Approved lor ConsVuction <br />Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />1 Everett, WA 98201 <br />Phnne 259-f3615 <br />•: <br />�CKNOWL�D6EIJiENT OF GOND�TIONS <br />The undersigned owner/applicant hereby agrees to hold and save harnr <br />Ic,s the Ciry of Everett from any and all claims lor damages, cosis. <br />expenses. or causes of aclion �hat may arise because ol installalion <br />and maintenance of ihe improvement or other right-of-way usr; hereto <br />applied for and further agrees to remove same upon notice (rom the <br />City and lo replace public property damaged thereby. <br />Signature of Applicant Da�e <br />WORK AUTHORIZED RY THIS PERMIT MUST RE STARTED WIThiIN <br />180 DAYS OF DATE FERMIT IS ISSUED AND THEREAFTER IS T() <br />BE DILIGENTLY PURSUED TO COMPLETION. TFIIS' PERMIT MAY B[ <br />CANCELLED BY Th�[ CITY UPON ANY STOPPl.GE OF WORI<ON THIS <br />PRGJE�;TOVER 90 Dr�`!> DURATION. <br />