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,��— �— <br />1� <br />i <br />�= i' <br />o�;.,-: _.� ..., <br />Date g�Zs-��! <br />Applicalion For <br />PUB�.I� WORKS PERMIT <br />Print or Type Only <br />Au01ic Works Penei�' �x� ✓� `r�� ����n' <br />bino.00ni.. � �/�X'�C�— <br />Public Works Fee S, <br />To�al Fo� <br />les: Anni Fee Vaia S <br />e:��,�-�., �,,, 5 .�r— <br />i}�P��irn� �tSi�rf�l� F�O, l�rrr,-Si'� LG�F S��Pv�Rs� ���"ZSS �53�-ZGZ <br />Owner ldai!ing Address City Zip Phone <br />APPG-ant <br />Describe Proposed Work <br />Project Address (if known) <br />6laiting Address <br />City 7_ip Phone <br />��Itar.h four (4) copies of plans ��or proposed work - Draw io scale an�l note lhe follow�ng as applicable: <br />• Properry Lines a Center:ine of street <br />O Outline and dimensions of all existing and • Indicate North <br />proposed structures on !he lot ! Show any proposed gradiny changes <br />• Existing and proposed utilities e Show measurements <br />PERMIT CONDITIONS <br />t. All calls (or insnection shall be made 24 hr�, in advance - plione 259•889 5. <br />2. All work shall be perlormed in accordance with this permit and current City cf Evere�t Design and Construc�ion <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. �e(ore you dig. TOLL FFiEE NUMBER 1-800•424-5555. <br />:'��y� . � . . . � � .,. <br />_ <br />:�,U�t �rt i.�; i)i � fi�:���.i -;y�:i-i P.I <br />�iv �r�� c�,;r-,n� r,ian�ac�s w�.isi- �_-:: ,:;;.; <br />r-�ui.�.ic wai:� �' r.iu�r-�cr:�r,. <br />7�K:Eff:P C;II"Y STREF'I'S LLI=AiJ r1T AL!._ l"� ' <br />6.II�ISTf;LL. WpTI:F' t-��.;rc: -t,. �„r.:,n;.-: .;,- - <br />��'..ra^�I�'C r�.lr.�' .}r;7i...� . �. � <br />.�r , :r.. _ ., . <br />Approved for Construction i jD:� <br />G �G, <br />FINAL I SPC-CTIO Dale <br />Approved as Constructed <br />everelt PUBLIC WORKS DEPARTMENT <br />� 3200 CedarStreet <br />Everett, WA 98201 <br />Phone:259�8875 <br />ACKNOWLEDGEME�i OF CONDITIONS <br />The undersi9ned owner/applicanl hereby agrees to hold ar.d save harm- <br />less the Cily ol Everett from any and all claims for de�mages, cos�s, <br />expenses, or causes of aclion that may arise because o( installation <br />and maintenance ./ the improvement or other righbof-way use nereto <br />applied tor and lurther agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />WORK AUTIIORIZED BY THIS PERMIT MUST BE °TARTED WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND T!tEREAFTEP IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. Tr11S PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON i HIS <br />PROJECT OVER 90 DAYS DURATION. <br />