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Date J� �p � <br />Application For <br />PUBLIC WORKS PERMlT <br />Print or Type Only <br />1� I �i7Ji�`���i� i� ll��'�� <br />Pellinp Adr:�esa City <br />�dGl¢ WnMs Pa�mit s j�/�.��—�,]�] � <br />Ni�B �eP� . � / ,'_.j.1,;��__ <br />� <br />Fueiir Worw� Fae <br />Totel Fea s — — <br />lef��GC� F..eYUE 6__.. __ <br />d�lanca0oe S <br />��� ���_ c� <br />Zip Phonr <br />(. �-�J��_��" f\ _ <br />Applicei�t 1Aa:lingAddress City Zip Phone <br />Dnacribe Propos5d Work �� i tinnl _. __ _ <br />c <br />Pio�ecl Address (il Ynown) �'�(� � �� �� `����� <br />Altach low (4) coples of plans lor proposed work - Draw to scale and note the following as applicable: <br />• Property Linas <br />• Oulline and dimonclona of all nxistinp nnd <br />proposed structures on ihe lot <br />• Exlatinp and proposed ulllities <br />PERMIT CON�ITI6NS <br />• Cantedire ol street <br />• Indicato Norih <br />• ShoW any proposed gretlinp changes <br />• Show meesuremenls <br />1. All calls lor inapeetion ahell be meue 24 hrs. in advence • phone 259•881 5. <br />2. All work shall be perlormed in accac ance with this permil and current City ol Everett Design and Cons�ruc�ion <br />Standxrds and Specificationa. <br />3. Call Locatlon Underground Service 48 h�s. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />Z? ,�/i/�7 <br />/ `�f3C� �C. (�cio�C'i� S' /7�.r'�:�.T� ,�L/c�7' 1-',�-�r'�,�..���lJ <br />��� <br />� <br />App�oved lor Conslrur.lion <br />FINAL INSPECTION <br />Approved es I;onstructod <br />eve�e�t PUBLIC WORKS DEPARTNENT <br />� 3200 Cedar Sireet <br />EveretL WA 98201 <br />F'hone�. 259�BS15 <br />Date <br />Dete <br />ACKNOWLEDGENENT OFCONDI�IONS <br />� <br />� <br />� <br />The undersigned owno�/applicar! aereby eg�ees U held and seve haim- <br />less the City ol Everelt Irom any and all claims foi danidyes, cosis, <br />ezpenses, or causes o� ac�ion ihe� mqy arise because ol inslellation <br />and maintenance of iho improvement or olher righl-ol�way uae hereto <br />apP��ed lor and furihei agrees to remove same upon notice frcm ihe <br />City and lo replac�blic property demogEd Ihereby. <br />� �, � .� �-�$�" <br />Signa �e 1 pP cai.t Dete <br />WO K AUT CRIZEG BV THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATC f'CFh11T IS IS�UED ANO TFIEREAFTEfi IS TO <br />8E DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED 3V THE CITV UPON ANV STOPPAGE OF WORK ON iHIS <br />PROJECT OVER 90 DAYS OURATION. <br />