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��� <br />A�� <br />>H[n <br />� � � <br />�V1H <br />�XQ <br />1'] C7 <br />OH <br />H/��g <br />y�Y � <br />� f� � <br />H <br />HH <br />gy <br />� <br />C] C7 V� <br />CCr <br />���� [s1 <br />�Htn <br />HOCn <br />� <br />w� <br />� Dats � r ��!' <br />ppplicalion For <br />PUBLIC WORKS PERMIT <br />Print ur Type Only <br />���b <br />(1wne� <br />C1�Y <br />�'< i� <br />p�D���.1Yorke Perm�l • <br />Bldp.�lCl Y ���� <br />Putl¢ WaA� Fee S -�_ <br />Totel Fee <br />Laeeroo�FeePeia S ^Q�-- <br />Balance0ue S "� ____ <br />�� � <br />Describe Proposed Work ^ � �.� � �F�Ty <br />Project Address (il known) <br />Atlach tour (4) copies ol Plans for proposed work - Oraw to scale and note the following as applicable: <br />i Centedine ol sireet <br />• Property Lines • Indicate North <br />! Oulline and dimensions ol all eaisting and � ghow any proposed grading changes <br />proposed struclures on Ihe lot � Show measuremenls <br />• Exisling and pioposed utilities <br />PERMIT CONDITIONS <br />1, All calls �or inspetlion shall be made 24 hra in advance - Phone 259•881 5. <br />2. All work shall be performed in accordance wiUi Ihis permit and current Ci±y ol Evewtt Uesign and Consiruction <br />Standards ar.d Specilications. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOIL FREE NUMBER 1-800•424•5 . <br />r - - C.a C. G_ <br />�j/ ,C�I�f 'f �Y/1 �/T /5�a c' �., <%i i F�ELJ C /✓c-.. <br />. <br />L JC.ti i/r � � E� %c/TC'•�'� <br />�� � � � �,�.� �-� �,� ' 91�1�� <br />� <br />�� n_— J 1„ p�� (��(��y��� ACICNOWLED�CONDITIONS <br />�NN Vd •v• • a/ <br />"��.�7Cy�iy '��`'%h'S <br />Approved tor Con � uction <br />� Date <br />i lb I(o 2_ <br />FINAL INSPEC710N ate <br />Approved as Constructed <br />everett �UBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phonc:259�6875 <br />W <br />H <br />�w <br />_ / <br />� <br />O <br />The undersigned owner/applicant hereby agrees lo hold and save harm� <br />loss Ihe Cily ol Everel� Iwm any 2nd all claims for damages, costs, <br />eapenses, or causes ot action tha� may arise hecause of inslallation <br />and maintenance ot the improvement or other righbot�way use hereto <br />applied tor anc turiher agrees b remove same upon nolice irom Ihe <br />City and to repl�ce puUlic property damaged thnre6y. <br />. � iV � � ,R <br />SiBnet�frc of pplicant <br />WORK� ORIZED 8Y I�HIS P�RMIT MUST BE STARTED WITHIN <br />180 DA\'S OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSU[D TO COM1IPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OV[R 90 DAYS DURATION. <br />