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Date __U��`( <br />Appilcatlon Fot <br />PUB�IC WORKS PERMIT <br />Pririt or Type Only <br />�iMi 'C� <br />Applicant <br />Describe Proposed Work <br />Pro�ect Address (il known) <br />Address <br />E�, �--- w �- <br />Cily Zip <br />City 2ip <br />Attach Ieur (4) coples of plans lor proposed work - Draw to scale and note the following as applicable: <br />• Properfy Lines <br />• Outline end dimenslons ol all existing and <br />proposed structures on the lot <br />• Existing and proposed ulilities <br />FERMIT CONDITIONS <br />PopM1c Y�orks Pa�mlt • �`� /� <br />oiau.oaoi.. �/ a.O�S�— <br />PuGI¢WmbFee s <br />Toial Fee <br />Losa Appl Fee PaiU S-/ <br />ilalance�ua s 4GJ�� <br />• Certerline of street <br />• Indicate Nor�h <br />• Show any proposed grading changes <br />• Show measuremenls <br />s�C r,� <br />�.,.r.�_ a s� <br />Phone <br />Phone <br />1. All cells lor inspection shall be made 24 hrs. in advanca � phone 259•881 5. <br />2. All work shall be perlormed in accordante with �his permit and current City ol Everett Design and Consiruction <br />Stxndards end Specilicetiona <br />3. Call Locatiun Underground Service 4B hrs. belore you dig. TOLL FREE NUMBEA 1•800•424•5555. <br />' J /� s <br />Approved )or-G� uction � <br />�j✓ / <br />�< / jo?-�!!-f� <br />FINAL INSPECTION`" Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259�8815 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />L J <br />� <br />� <br />� <br />a <br />7he undersigned owner/applicant hereby agrees to hold and save harm- <br />less lhe City of Lverett Irom any and all claims lor dameges, co �ts, <br />expenses, or causes ol action that may arise because ol Instalfatlon <br />and maintenance ol Ihe improvemenl or othe� righbof�way use hareto <br />applied lor anC lurthe� agreec to remove same upon notice from Ihe <br />City and to replace public property damaged Ihereby. <br />� � � � ���0,� <br />Signature ol Applican� Date <br />WOFK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUEC TO COMPLETION. THIS PERMIT MAY BE <br />GANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />a <br />0 <br />� <br />.. <br />c� <br />m <br />.. ... <br />-� �t <br />.+-i <br />v� x <br />v <br />m <br />co <br />m� <br />-� c <br />03 <br />i1 <br />m <br />o z <br />c <br />a -+ <br />rx <br />.. .. <br />�� <br />� <br />O A <br />T 3 <br />-� m <br />x <br />m �-. <br />� <br />0 <br />or <br />c vi <br />mN <br />z c� <br />-� r <br />. m <br />a <br />� <br />� <br />x <br />a <br />z <br />--� <br />� <br />N <br />Z <br />0 <br />� <br />� <br />m <br />