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Date "� �� �� <br />� Applicalion For <br />PUBLi� W�DRKS PEF�NIIT <br />Print or Type Only <br />� ;e <br />/3�/.S <br />iilinq Address <br />Address <br />c��y <br />Ci!y ZiP <br />Fubhc Wa�Fs Permtl a <br />=7au ^ Z✓ P <br />o�a9 o�a� < 8� lri5��' _ <br />Puohc Wo�ks Fee � <br />Tola1 Feo <br />Less Ap01 Fee PaiJ S%O� <br />Balance �uc 5 ._— <br />- 3.�35 <br />Uescribe Proposed Work ��"�`rT,FG�'iy Siz�GGE FAmiL// �G-�S/<')C�✓C� _, <br />Proje��c Address (i� knownl �L � z�� <br />Attach four (4) c,opies of p���ns for proposed work - Draw to scale and nole the tollowinq as applicable: <br />• Properry Lines <br />• Outline 2nd dimensions of all ezisting and <br />propos2tl slructures on �he lot <br />• Existing and proposed utilities <br />ir Centerline of street <br />• Indicate Norlh <br />o Show any proposed grading changes <br />(► Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor insFection shall 6e made 24 hrs. in advance - phone 2b9•881 5. <br />2. Ail work shall b•: performed in acco�dar�ce with thia permit and curren� Cily ol Everett Design znd Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 46 hrs. Uefore you di�. 70LL F?EE NUMBCR 1•�800•424-5555. <br />H7U�1�"�� <br />FINAL INSPECTIDN \ \ � <br />;,pproved as Constructed �\� <br />everr�[ PUBLIC WORKS DEPAHTMENT <br />�3200 Cedar S�reet <br />Everett, WA 98201 <br />Phone: 259-8815 <br />/1 <br />Date <br />Date <br />ACKNOWLEDGEMENT OF C��NDITIONS <br />The undersigned ownedapplicanl Y�ereby agrees to hold and save harm- <br />less the City ol Everett irom any o�d all clairt:s for damages, costs, <br />expenses, or causes of action ihat may arise because of in&tallaGon <br />,anJ ^�aintenance ol ihe imnrovement or other right-ohwa7 use herelo <br />applied tor and furlher agrees to remove sama upon notice Irom the <br />Gity and to replace public property �amagcd lhereby. <br />'? � .[� <br />J <br />�' 1-L�irtiG� G_ 4'�"C'L' �!'-1 <br />Signalure of .4pplicant Daie <br />WORK AUTHC�iIZED BY THIS PERM1IIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS iSSUED AND THcRcAFTEFI IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT IdAY BE <br />CANCELLED [3Y THE CITY U?ON ANY STOPPAGE O� INORK ON THIS <br />PROJECT. OVf=R 90 DAYS DURATION. <br />