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�HIn <br />K n <br />H � <br />OH <br />�0038 <br />0• 0 <br />>H� <br />tt""HH <br />gcoo <br />H <br />AC❑F�y CA <br />H E6 <br />HOin <br />Date T / I r'° ' <br />Application For <br />PUBLIC WORKS PEiRMrr <br />Print of Type Only <br />Lily <br />71 m, c <br />Applicant <br />Describe Proposed Work <br />Project Address fit known) qX - Opp A - <br />PublC Wmx. Permll • _ p <br />09kp pool . 9 (� <br />Zip <br />Public WaM Fee e <br />rider Fee <br />Laos Awl Fee Paid <br />8.1sece pus <br />Attach four 141 copies of plans for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All cells for Inspection shall be made 24 hrs. in advance- phone 259.8810. <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. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800.424.5555. <br />Approved for Construction Date <br />FINAL INSPECTION i Oate <br />Approved as Constructed <br />WffPUBLIC WORKS DEPARTMENT <br />3200 Ceder Street <br />Everett, WA 98201 <br />Phone: 259.8810 <br />Al-2 <br />W <br />Ya/ <br />0 <br />Z <br />0 <br />0 <br />A. <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 ell claims for damages, costs <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other righl•ol-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 Date <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 />CANCEL--.ED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJEFJ OVER 90 DAYS DURATION. <br />.I <br />