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Date�.11L::`_ � % <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�?,��wi�1 ��r;r�;-f- <br />,� <br />Ownnr <br />Atltlf@SS <br />�r�,���� <u <br />Zip <br />PaGbc Wo�Ma Permit � <br />s7-� as' <br />�iaB DeGt. s � <br />^uei¢WorheFea § <br />Tolsl Far <br />Lesf AppL Fee Paia S ql, <br />Balanca Due $ <'^� <br />Describe Pr�posed Work 1 R'�� �`��1—" _ <br />Pro�ect Address (if known) '�'��2-3 '� aF✓�.t'L�/ %3t ✓�. , <br />—T <br />Attach lour �4) copies ol plens for proposed work - Draw lo scale and noto the following as applicable: <br />q PropeRy Lines • Centerline oi stroet <br />O Outllne and dimensions of ell existing and • Indicete North <br />proposed struc'••res on the lot • Show any proposed grading changes <br />� Existing and proposed utilities • Show measuremnnis <br />PERMIT CONDITIONS <br />1. All calls lor inspoctlon ahall bo made 24 hrs in ad�•ance • phone 259•881 5. <br />2. All work shall ba performed in accordance with this permit and current City of Everett Design and Construclion <br />Standards and Specificationa <br />3. Call Location Undargraund Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�,� SiOfi���,C f%u0 l7,E'iU_fs.F.�� %�PE .�lE/J %�•vl� <br />llNB.c'o,c'.s`'N� f�N� .OR�n,q�= Sy�lL dE �EP�,qcf0 <br />�f/ %.5�� .<JPDl�IF,'NT. <br />FINAL INSPECTIOIJ <br />Approved as Cons�ructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Slreet <br />Everett, WA 98201 <br />Phone: 259-.^815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />� <br />I� <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />Tha undersigned owner/applicent horeby agrees to hold and save harm• <br />la;s the Cily ol Everett irom any and all claims lor damages, costs, <br />exUenses, or c�uses ol actien Ihet mey a�ise becausa ol instellallon <br />end meij�tenance of the impnvement or other dght-ol-way use hereto <br />applindJibr end luriher �rees to remove snmo upon nolice Irom the <br />City an�l jo replace publ/c property damaged thereby. <br />��1, <br />W AUTHnFIZED BY TH�S PERMIT MUST BE STARTED WITHIN <br />1 DAYS OF DATE PERMIT IS ISSUEO AND THEREAFTER IS TO <br />8 DILIGENTLY PURSUED TO COMPLcTION. THIS �ERMIT MAY BE <br />CANCELLED BV THE CITY UPON ANV STOPPAGE OF 6VORK ON THIS <br />PROJECT OVER 90 DAYS OURATION. <br />