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Date 3' 22-y�}- � I r�e���wo,�.v.,�n. � Z <br />Applicatior For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />'�A1 �IY <br />Owner <br />Aoplicant <br />ZZSOV - �Cvtl� <br />Mailmg Address <br />Mailing Address <br />BiCo Oeot • <br />FuElrc Wo�kt F!e <br />Tolel Fee : <br />Leu ADC� Fee Pa�C �1 <br />Baiann Due s . '�L� <br />Describe Proposed Work S� � �OD G V�� L�/?.��C Fj � � _ <br />� <br />Prolecl Address (il known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note �he following as applicable: <br />• Property lines <br />� Outline and dimensions of all existing and <br />proposed structures on fhe lot <br />• Existing and proposed utili�ies <br />• Centerline of siree� <br />• Indicate Norih <br />� Show any p�oposed gr3ding changes <br />• Show measurements <br />PERMITCONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259-86i U. <br />2. AI� work shall be pedormed in accordence with this permit and current City oi Everett Design end Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dlg. TOLL FREE NUMBER 1-800-424•5555. <br />g� /t5 �rr.r a�Pra✓Pd p�an dated 3-2z-9�4 a�i Sepa� �13-�tv. <br />5 Ke�p c�6y streeFs ���:a�.,� of d,r�t � d�b,r;s �t.a!I ttrvie,s. <br />App�ed for CAfi3NLdion / / Datcr <br />���D <br />/��lfi{W� f���¢-06 <br />FINAL INSPECT16N Date <br />Approved as Conslructed <br />�PUBLIC WORKS DEPAP.TMENT <br />�3200 Cedar Street <br />Evcrett, WA 9B207 <br />Phone:259-8810 <br />qCKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant here6y agrees lo hold and save harm- <br />less t�+e Glty of Everett irom any and all claims lor damages, costs, <br />e■pe�ises, or causes ot action that may a,ise because of installation <br />and maintenance of the improvement or oth�ar right-ot•way use hereto <br />applied for and further ag�ees to remove same upon notice Irom the <br />City and to r�lace public property damaged thereby. <br />S�naiure ol Applicant � Dale <br />1NORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEREAfTER IS TO <br />6E DILIGENTLY PURSUED TO COMPIETION. THIS PERMIT MAV BE � <br />CANCEILED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS ��. <br />PROJECT OVER 90 DAYS DURATION. . <br />