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Date X:�?d/d' � <br />�ri <br />' Application For <br />PUBLIC WORKS PERMIT <br />,-, <br />Print or Type Only <br />HOOfQ55 <br />Oescribe Proposed Work <br />Pro�ect Address (if known) <br />: . . ,.,, ,�u,,.,�,. , . . _. , ¢_. -, <br />� <br />Puohc worb naimn s _ <br />Bidp DePI. � — �i in � �� 7 � % <br />PuObc Worxe Fee <br />Tolalfee s <br />lesf Appl Fee Pa10 S <br />dalance Oue $ <br />...�JSS <br />A1 N�1ri �1 f.�—��-5 /� r-� <br />Z�P Phone <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the following as applica6le: <br />• Property Line: • Cen�erline of stieet <br />• Outline and dimensions of all existing and • Indicate Norih <br />proposed struclures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspectlon shall be ma�e 24 hrs. in advance • phone 259•881 5. <br />2. AI� work shall be performed in aa;ordanca wilh this permit and curtenl Cily of Everetl 7esign and Construction <br />Standards and SpeciliCetions <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />/1/d �iFG�G <br />��%Dr� SF�c.;-'.E= <br />!,G/O/�,�:5 f?=i��?J,�T f_'rG�v�.�;r./� <br />`l'.e: Tf✓iS �/''i ,�-,�_. /,�/G G dr <br />G-�/OF,�= v-o�%,��,-U r;'L>L� T/O,r/ <br />. <br />/J � /�� -�7--��� r o�� <br />P/Pr /71�'%r i�"/r�'C . <br />J�' - r:�rlf-:��. -_.. _'_. =i. '�-i. ,',:/� ;� <br />Approved �or Construction Date <br />FINAL INSPEC710N Dale <br />Approved as Constructed <br />everett PUBLIC WORKS 0[PARTMENT <br />� 3200 Cedar Street <br />Everett WA 98201 <br />Phone: 259�8815 <br />/9Pvilf�:�/T .[J��_F�S <br />TLJ �%�i �/✓lT LC <br />,�,,�1 <br />3/�? f/�9� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OP CONDITIONS <br />The undersigned owner/applicant hereby ag�ees to hold and save harm• <br />less the City of Everelt irom any and all claims lor damages, costs, <br />expenses, or causes of action that may aris• oecause of mstallation <br />and maintenance ol the improvement o� othc ,ighbof-way use here�o <br />applied lor and f�Sr�her agrees to re ove same upon notice Irom Ihe <br />City and to repl�Ee public property d�nagec� there6y. <br />aigna�ureui nppucan � Da�e <br />WORK AUTHORIZED Y THIS PERMIT MUS E STARTED WITHIN <br />180 DAYS OF DATE ERMIT IS ISSU D AN THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TNIS <br />PROJECT OVER �JO DAYS DUP.ATION. <br />