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Application For <br />PUBLIC WORKS PERMIT <br />Public worse Permit • / <br />2// <br />Bldg Dept. • S3 a <br />Public o Works Fee `� <br />ks <br />otal Fee <br />t ass Appl. Fee Paid It �— <br />BHrn<e Dua •�'C•m0 <br />Print or Type Only 1e W47 <br />Describe Proposed Work <br />Project Address (If known) <br />Attach four (4) copies of plans for proposed work • Draw to scale and note t e 0 erline of err ell able: <br />• Property Lines • Indicate North <br />• Outline and dimensions of all existing and • Show any proposed grading changes <br />proposed structures on the lot • Show measurements <br />• Existing and proposed utilities <br />L <br />PERMIT CONDITIONS <br />1. All calls for Inspection shell be made 24 hr& in advar. .e • phone 259.881 5. <br />2. All work shell be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specification& <br />3, Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1.800.424.5555. <br />,/ •� 1 q cioes�o� rite.-. '-'4'�+ aSrca w•� <br />'j/ tYr. vaww�3 •n 1rtC I �Ah <br />' d-l.e •�• ld- T•� <br />CL"+ ..✓1 <br />�r..i cww� <br />C14 s'lPI <br />loot re-% s1 o . <br />�,. 1Gci ..�e-co.� 3 • 3. <br />w.<l•41� <br />ti.as. ;Lo <br />s, _'-(- -.UC <br />sewer Is <br />w.wa:- ba r'ev•ae.0 4,,k <br />ale.ertasl..,c t.. e. r <br />is <br />C1 toN-o'.3ks <br />��.�pa Per �l Plate Lo y <br />z <br />O <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownerlapplicant hereby agrees to hold and save harm* <br />all claims for damages, costs. <br />less the City of Everett from any and <br />that may arise because of ine'.alletlon <br />G <br />8 —Z 3 _e 3 <br />expenses, or causes of action <br />and maintenance of the Improvement or other right-of-way use hereto <br />to remove same upon notice from the <br />Dale <br />applied for end further agrees <br />City and to replace public property damaged thereby. <br />pproved for Co <br />` <br />J /Y 4) <br />FINAL INSPECTION <br />Approved as Constructed <br />Data <br />Date <br />Signs of App Icanl <br />Wo AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />PERMIT IS ISSUED AND THEREAFTER IS TO <br />everett PUBLIC WORKS DEPARTMENT <br />180 AYS OF DATE <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />3200 Cedar Street <br />Everett, WA 98201 <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />Phone: 259.8815 <br />i <br />PROJECT OVER 90 DAPS DURATION. <br />