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r <br />"I <br />ll <br />L <br />r <br />Date5_L(,_9 3 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />s <br />I <br />Describe Proposed Work k✓ < q" 'i S d — n iq— <br />Project Address (if known) <br />Public Wort Porrein • 83 ��_ <br />BWa Dept a 11 zzl9 / is, <br />Publ.c Work: Fee <br />Tani res <br />Less Ami. roe Pace <br />Balance 0" <br />6' L <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the following as applicable: <br />• Property Linea <br />• Centerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />Proposed structures on the lot <br />a Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />Phon-- �aT <br />PERMIT CONDITIONS <br />1. All calla for Inspection Shall be made 24 hra 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 Servlce 48 hra before you dig. TOLL FREE NUMBER 1.800-424.5555. <br />�. 3w.lder -kic, orte.i- �o+se 4. ulc axe's+.t„ <br />ATwe... Ill re5a.ij `kc e?44il a dr. 'e ..� :., �E c <br />Tt v.+.kv♦ Pef �Jta'r.on 3,�.i, mt t�l ur EJa.[e14 <br />1 <br />W <br />Ch <br />Im <br />O <br />on <br />z <br />0 <br />a1L ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm• <br />lees the City of Everett from any and all claims for damages, coats, <br />expenses, or causes of action that may arise because of In=rallation <br />,f =]O _ P3 and maintenance of the Improvement or other right-of-way use hereto <br />vetl for Canatrucuuuoeen Dale so or and further agrees to remove same upon notice from the <br />yen t replace public property damaged thereby. <br />FINAL INSPECTION Date _ <br />Approved as Constructed S nature of Applic t Date <br />everett PUBLIC WORKS DEPARTMENT WORK AUTHORIZED BY THIS PERMIT MUST B ARTED WITHIN <br />3200 Cedar Street 180 DAYS OF DATE PERMIT IS ISSUED AN HEREAFTER IS TO <br />Everett, WA 98201 BE DILIGENTLY PURSUED TO COMPLETION, THIS PERMIT MAY BE ' <br />Phone: 259.8815 CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />a <br />PROJECT OVER 90 DAYS DURATION. <br />1 <br />1 <br />.J <br />L <br />J <br />