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Date�`/� ��'< ,� _ ", � ,j <br />'C �/ � <br />Application For <br />_ PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing <br />iE � �✓r,c' <br />c��} <br />- iir i 'r �T i_ <br />��,.�,�,�,�o,,, �,,.m., , _ln - /I�? <br />���e Oeo� . -- <br />����,� Wo,�, �., s <br />TOI�t� �PP <br />Lrss PpCI fee Pau1 $ _ <br />Balan�x0uc S. e�� `�, <br />C/����5 �v7- �c.5�6 <br />Zip Phone <br />Describe Proposed We� � �Y�%t N%/�N OF- �f _Sc v.'c iC ir //�c- Oiv-To r�iS�✓c � <br />11i2�" f—�. AN,7 !-/,'z�r ��' ,�,v>n �, r w c=i: <br />� <br />PrOject Address lil knowr� <br />Attach lour (4) copies ol plans lor proposed work � Draw to scale and note ihe foliowing as applicable. <br />• Prope�ty lines <br />• Outline and dimensions ol all existing antl <br />proposed structures on ihe lot <br />• ExistinQ antl proposed utilities <br />• Centedine ol street <br />• Indicate No�ih <br />• Show any proposed g�ading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calis f��r inspection shall be made 24 hrs. in advance � phone 259•8810. <br />2. All worM shell be periormed in accordance with this permit and currenl Ciry ol Everett Design and Construction <br />Stendards end SpeciPcations. <br />3. Call Locelion Underground Service 4B hrs. belore you dig. TOLL FREE NUMBEH 1•80�1�95��31RM d00pNOB05 <br />/ <br />n <br />`�. LdJo,�',r T�� BE Doti't- f c �c A/�i'�' ����'�J J�c _Fi! DPT.20t 5�0.00 <br />,a�rF� y-3 9�'• <cv�/�����.co> CHECI; s2o.00 <br />�' �'p,�/�t/�C'Ti�.�./ <br />�������� � <br />T 7ff� <br />�EP��'AT� <br />f3[�i[Di/✓G- � l��iL L <br />SiOE <br />�v�US/�'c�c-i�oN �` ,�S�c=CY�iJ� f'�`� c�c�S/.s/t� <br />� � C��J'��'�rT on� srr�.�.�,E'r21' o� �'j � ��� <br />. �y��,�� -�� <br />� <br />A roved lor on tion 3 `Da e <br />�C�Ui" /-�-8-9i <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everetl PUBLIC WORKS DEPARTMENT <br />� 3200CedarStreel <br />Everet4 WA 98201 <br />Phone: 259�8810 <br />ACKNOWLEDGEMENT OP CONUITIONS <br />W <br />F- <br />N <br />r <br />N <br />O <br />a <br />The undersic�ned owner/applicant hereby a9rres to hold and save harm� <br />less Ihe Clty ol Everelt I�om any antl all claims for damages, cos15. <br />e�penses, or causes ol action that may arise because ol installation <br />and mainlenance of the improvement or other .�ght�ol�way use hereto <br />applied br and lurther agrees to remove same upo� notice ��om Ihe <br />Cily and to replare public property damaged iheieby. <br />' �. `, .,.�/c� � <br />i i �%1,�:,: ..- i`�. /• �T-- c�/�.� � . <br />Signature ol ApPlicant � Datr. <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO GOAIPLETION. THIS PEFMIT MAY B[ <br />CANCELL[D BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />