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Date � � g�� <br />Application For <br />PUBLIC WORKS <br />Print or Type Only <br />��g�R � JRNSc-rt- <br />Owner <br />R�gc-ri� SR�4cvz. <br />Applicent <br />Describe F/rqoosed Work <br />.� 1 / ��c ._ . � <br />Project Address lil 4nown) <br />8 <br />N <br />P�MIT <br />rg O O <br />�i � � <br />� <br />� �nr, � W� .q e � zs <br />i Ciiy Zip <br />loz� nlC- � <br />Mailing Address <br />)� � <br />Mailin{1 <br />Pue',¢ Woihs Permit � __ �� �V_ c' — <br />piJQ OeO� � — <br />Popbc Warkf fee �% ' <br />Tolal Fee s T�f=� � <br />LoaAO�� FeePaiO S <br />�a/�—,—�— <br />9alance Due S �i(�// �i) <br />--,����c un t9�Zs 3h3-io <br />Clly Zip Phone <br />��v.B��C ��� Sn�w1�ZA2y SC-�..�.--ti �P�PE AC.RaS� utST <br />TOA�.— �Lt. Tos��'.ND 'i�RLF A['fc�=TF_Rt:C. <br />To �- <br />Attach four (4) copies ot plans for proposed wur: • Grew to scale and note the lollowiny as apPGcahle: <br />• Proper�Y Lines • Centerline ol street <br />• Outline and dimensions oi all�existing and • Indicate Noith <br />proposed str�ctures on the lot • Show any proposed prading changes <br />• Exisling and proposed utilities • Show measwements <br />PERMIT CONDITIONS <br />i. All calls for inapection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be peAormed in accordance with this permit and current City of Everetl Desi9n and Constru�tion <br />Standards and Specitications. <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�, /��- ��:,�-�...���o�,s <br />� <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200CedarStreet <br />Everett, WA 98201 <br />Phone:259�8810 <br />Da�e <br />�i�� Z-7-�U <br />W <br />� <br />� <br />N <br />� <br />0 <br />F- <br />� <br />O <br />a <br />ACKNOWLEDGEME4T OF CONDITIONS <br />The undersigned owneUappl�cant hereby agrees to hold ana save harm� <br />less ihe Cily ol Everelt Irom any and all claims for damages, cos�s, <br />expenses, or causes ol aclion Ihal may arise because of installation <br />and maintenance ol ihe improvement �r other right�of-way use hereto <br />applied for and furlher ng�ees to remove same apc^ �Mice from the <br />Cily and to replace public propeny damaged thereby. <br />"9� ��,����. � ���� U <br />Date <br />Signature ol Applic t Date <br />VlORK AUTHORIZED BV THIS PEHMIT M ST BE STARTED WITHIN <br />I80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIIiENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TNIS <br />PROJEGT OVER 90 DAYS DURATION. <br />