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NPE OR PRINT ONLY <br />Applicant <br />Describe Proposed Work <br />r � ocrv,q <br />Applicalion For <br />PUBLIC WORKS ��ERMIT <br />PROJECT ADDRESS (if known) <br />PU6LIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everetf, WA 982G I 259-8810 <br />City <br />City <br />���� P� oF D P �R ' .. <br />Date �� / 8 l <br />Public Works Permit s _/� �Q(e <br />Building Permit # <br />Public Works Fee $ �SQ O � <br />� _ _ iSctS� <br />- 9'N A✓r i.J ��� 20 <br />Attach foar (4) copies of plans for proposed work - Draw to scale and note the (ollowin if a licable: ���'� �'�'/ 9gz0 8 `�' � <br />9 PP ��QGS, <br />•Property Lines •Outline and dimensions of all existiny and proposed simcWres on ihe lot •Existing and proposed utilities <br />•Centerline of st:eet •Indicate Norih •Show any proposed grading changes •Show measuremenis � Q� <br />PERM'T CONDITIONS: <br />1. AII calis for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be pertormed in accordance witl� this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underyround Service 48 hrs. before you dig. TOL! FREE NUMBER 1-800-424-5555. <br />�{ l�irn�E' � <br />9� - ye <br />ooe-�e �D�r �t4h <br />� o�cy a�1% c �¢d, <br />4��hov� d� vh <br />5, �/y;l:�y �' �S��et` l��ho�� n�e� ,wo-�`- -, or z�;s <br />�l%hofe c�' �'� y viin J ��i 4� ��.oh a� �O¢riri<7� <br />�� <br />lp. �G�jF� G'/� �S'f��'.s C124.� Qr�' 4C� �meS, <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save hartnless <br />the Cit of Everett from any and all claims for damages, costs, expenses, or <br />� - B p Y <br />Appr ed tor op tructio p� e causes of action ihat may arise because of installation and maintenance of <br />the improvement or other r;ghbobway use hereto applied (or and further agrees <br />/J � � to remove same upon notice from the City and to replace public property <br />�O �—(b —0� damagedl reby. <br />FINAL INSPECTION Date � <br />Approved as Constructed ' <br />� <br />o-�. �. - �- �� .� <br />Signature of Applicant — � ate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 780 DAYS Of DA7E PERMIT IS ISSUED AND THER R IS TO BE DILIGEPJTLY P RSUED TO <br />COMPLEZ70N. THIS PERMIT MAY BE CANCELLED BY THE CT' UPON ANY STOFPACaE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />