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•tes.�[�, <br />Applicallon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />—��' f s( I.J 7 �/S� <br />Owner MaUing Aduress <br />Applicent <br />Describe Proposej Work <br />I'roject Address �if known) <br />Attech four (4) copies ol plaris lor proposed work - Draw to scale <br />Y PrOperty Linos <br />• Outline and dimensions ot all existing and <br />pruposed structures on the lot <br />• Exisling e�tl proposed utllitles <br />Cit/ <br />Pu41¢ Worxs Permn � <br />_ _ y�____.. <br />fliEG OePt � _���/� .�.��. .—_.. <br />Puolicworh�Fee � <br />To1ai Fee -- <br />Leu �oD� Fae PuE : ,.— <br />9sis�icn Oue S _ <br />���a-a�i(� <br />Phone <br />[ip rnone <br />note Il�e following as applicabtP: <br />• Centerline ol sireet <br />� Indicate Ncrih <br />f �how any pro{.osetl gradi��y changes <br />• Show measuren,ents <br />PERMIT CONDITIONS <br />t. All calls lor Inspection shall be nade 24 hrs. in ndvance • phone 259-881 5. <br />2. All work shall be peAormed in accordance with this permit and current City of Everell Design anC Conslruction <br />Standards and Specificatlons <br />3. Cali Location Underground Service 48 hrs. betore you dig. TOLL FREE NUM��.Fi 1•800•424-5555. <br />���,�� `�,��, ��- ��e-�� .� <br />� � <br />G <br />✓ n <br />�� ,/�/����/ / C7 � <br />C/' <br />Approved toi ConsVuclion Date <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WOCKS DEPARTRIENT <br />� 3200 Cetlar Street <br />Eveiett, WA 98201 <br />Phone:259•BB15 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />z <br />0 <br />— � <br />., <br />C7 <br />m <br />W <br />� <br />� <br />� <br />� <br />O <br />The undersigned owner/applicant hercby ag�ees to hold and save harm� <br />les.^, the City of Eve�elt from any and all claims lor damages, costs, <br />e■penses, or causes ol action the,t may arisa because of installation <br />and mainlenance ot ihe improvemenl or other righPo4way uce here�o <br />applied lor and lurther agrees ic remove same upon notice Irom 1hB <br />City and to replece public proper,� damaged thereb��. <br />na�ure o� Applitan� <br />Date <br />WORK AUTHORIZED BV THIS PERMIT MUST 8E STARTED WITHIN <br />180 OAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DII.IGENTLY PURSUED TO COMPLETION. THI� PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE UF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />-�-i � <br />.. --� <br />N S <br />0 <br />m <br />�o <br />m� <br />om <br />-i z <br />x -i <br />m <br />.. <br />.o = <br />a -� <br />rx <br />r. .. <br />< N <br />� <br />O 70 <br />�n <br />—1 m <br />x <br />m� <br />N <br />0 <br />o r <br />c� m <br />3 tyif <br />i� <br />-� r <br />m <br />a <br />A <br />--1 <br />x <br />a <br />z <br />1 <br />._. <br />N <br />Z <br />O <br />--1 <br />C'� <br />m <br />