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Date_8�hc <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Wods Permit •^/ s-0CY63 <br />Did, Dept <br />Public Worts Fee 5, <br />Teal) Fee <br />Leas APPL Fee Paid �O• L'� <br />eel.ece sue <br />'%a m(?1 Zip Phone <br />Mailing Address City <br />Applicant <br />Describe Proposed Work t / <br />Project Address (if known) <br />Attach four 141 copies Of plans for proposed work - Draw to scale and note the <br />ne of atpeetcP5le: <br />• Property Linea • Indicate North <br />• Outline and e.,renslons of all existing and • Sho.v any f ,oposed grading changes <br />proposed structures on the lot • Show measurements <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />1. All calls for Inspection shall be made 24 fire. m advance - phone 259-881 5 <br />2. All work shall be performed In acc.xdance with this permit and current City of Everett Dasign and Construction <br />Standards and Specifications <br />3. Call Lo:alion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.55 . <br />/JJCJ C,4C41 11�51e <br />Approved for Constr tlon at <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />rie, <br />rPit PUBLIC WORKS DEPARTMENT <br />EverCedar Street <br />Everett, WA 98201 <br />Phone: 259.8815 <br />of <br />W` <br />I <br />a <br />Cl) <br />O <br />an <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all clnims for damages, costs. <br />expenses, or causes of action that may arise because of Installation <br />and maintenance of the Improvement or other right-ol-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace pubic Pr Arty damaged thereby. <br />Sig4AUo <br />plicant DatRMIT MUST BE STARTED <br />IN <br />180DAYS OF DATE PERMIT ISEISSUED AND THEREAFTER ISTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />-4 —n <br />H —1 <br />N x <br />m <br />m� <br />U 3 <br />—1 z <br />m~ <br />oz <br />c <br />r ~ x <br />H rr <br />T <br />CD X <br />—1 <br />S <br />m r— <br />N <br />o r- <br />crn <br />On <br />On <br />rl <br />s <br />a <br />z <br />�-1 <br />2 <br />N <br />