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Date ` �� <br />Application For <br />PUBLIC WORKS PERr T <br />Print or Type Only i'� POSTING �' 1�3 ��n� <br />Hppucani <br />Descrlbe Proposed Work <br />Pro�ect Atldress �il known) <br />�O �x iC�S <br />Mailing Address �i�Y <br />Address <br />Zip <br />Attach four �4) copies ol plans lor proposed work - Draw lo scale and note Ihe following as applic. ale: <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />proposetl structures on Ihe lo� <br />• Existing and proposed ulildies <br />Pupirc W�-ks Per n�1 • � � qq <br />! �Bl�g Uap1. t ,_ <br />Publ¢Wo�MSFce -- <br />TatalFae $ <br />less Anul. FeP Paitl $ <br />dalance0oe S z�%�' <br />• Centerline of sirtet <br />R Indicate Norih <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />7. All calls for inspection shall be made 24 hrs. in ad��ance - phone 259-8810. <br />2. �ill work shall be performed in acwrd�nce with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Under9rountl Ssrvice 48 hrs. before you dig. TOLL FREE NUMBER 1•$00-424•5555. <br />�. G:�;�'LI3,C�v�'[�"� �1N1� ��1� H.1�.L+'� ,c��.L NCW /kND VN L�CEG <br />� N11 .PAMAc,� S�n �� F;e �c �A i�c-� r� z. �� c tL�c�� r,�r i�rC-' <br />,�k��.�c ar.7T -t� TttC-� SATi s�rl ��-10�; 3� -r+rC I�i�� � G t� <br />i 1�( SPC-Z l C�fG, <br />5, ��e�= o�a.��ss <br />pe+���s. <br />�� �. c_orst.� � �(J Tr� �t-zc� c���,� <br />�R�� I I� / <br />�-� � �2S�9C� <br />Appruved or Consiruction � a1e <br />� �/ <br />�/��la - S / 7io <br />FINAL INSPECTION Date <br />Approved as ConsUucted <br />eve�ett PUBLIC WORKS DEPARTMENT <br />� 3200 Cetlai Street <br />Everetl, WA 98207 <br />Phone:2F9�8870 <br />ACKNOW�EDGEMENT OF CONDITIONS <br />� <br />� <br />� <br />� <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett Irom any and a!! claims for damages, costs, <br />expenses, or causes of action that may arise because of inslallation <br />and maintenance of the iriprovemeN or other righl-ohway use hereto <br />applied for and furiher ag�ees to remove same upon noticr, from Ihe <br />Cd��la to.rep �I �ce publi ronerty damaged thereby. <br />/u��.�'�` ii:7 �i'��. <br />i <br />%�. : � �1 E -r') /'�' �i '�Q <br />Signa re ol Applicani Date <br />WORK AUTHORIZED B',' THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PEFiMIT IS ISSUED AND THEREAFTER �S TO <br />BE DILIGENTLY PURSUED TO COMPLETION. TH�S PERMIT MAY 8E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TH�S <br />PROJECT OVER 90 DAYS DURATIOM. <br />