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OO� �' 8 s <br />Date�L',�'; Public Worke Par%j7 <br />Application For mO •� <br />Bldg Dept a - I <br />PUBLIC WORKS PERMIT Public WcA, Fee <br />total Fee e <br />Lees appl. Fee Paid a �� <br />Print or Type Only Balance Due <br />Phonn <br />Applicant Mailing Address City Zip Phone <br />t� <br />Describe Proposed Work <br />LU <br />Project Address (it known) �2 ' -5.E LOT 'r6 <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />O <br />1, All calls for Inspection shall be made 24 hrs. In advance - phone 259.881 5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />S1,0eWA7, t �_ CueBS ?9"e i/E4i .9uo u"47W-C41 A-j' <br />b4t)-7A6'E Tv Xftt'7 SHALL 61r �17CiQ-owei &y T.s'E <br />O <br />�gjO�LiLANT, <br />6, TiE C'cr�� Tao D'iUli vRvE iN1b PL�6'CiG 9iN.JGE <br />sy.STEM . <br />O <br />lC • ANj� G.e.�Q.NI!r O,nJ L UT TO dY" OLu/E S"o r?S ,x�OT TO <br />, j/nPAG f T.i'r W,7.1/ 4.1IJ-eXd1*'"i &A,40A' <br />Approved for Construction _ ' Date, <br />r ,r u ��, <br />FINAL INSPECTION ' \ ZS Date <br />Approved as Constructed V <br />E <br />relt PUBLIC WORKS DEPARTMENT <br />EverCedar Street <br />Everett, WA 98201 <br />Phone: 269.8815 <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 claims for damages, costs. <br />expenses, or causes of action that may arise because of Installation <br />and naintenance of the improvement or other right-of-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant F Da <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <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 />