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, .. , :. • . ,� �. <br />_. _ _ _-- - <br />Date�3�f �O \ `/ �1 <br />Appllcallon Fbr <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� <br />�' �„o � , /'lJ �i/'/ �„ <br />Melling Addreas <br />�>fl/1/E <br />Applicenl Meiling Add�esa <br />Deac�ibe Proposed Work _f��t,L<« l- ^ a� ` y - L <br />Pro�3ct Addresa pl known) <br />� <br />Poei¢ Worx� Permn • <br />eiau oeoi • � 7 2� <br />PUEI¢ WorM� h� <br />ToblFee �— <br />Len �DO� fea P��E d— <br />Bel�nce Due { _ <br />%'�.1/i.� ���0� <br />Zip Phone <br />2ip P�one <br />Allach four (4) coplea o� plana lor propoaed worY, - Draw to scale and note the lollowing ae epplica6le: <br />• Property Llnee • Centerline ol street <br />• Outtine end dlmenslona ol ell exfating and • Indicel� North <br />propOaed elruclurea on the lot • Show .^.ny pioposed grading chengea <br />• Exleting and propoead utilltiee • Show measurements <br />PEFMIT CONDITIONS <br />1. Atl calis lor inapectlon ehell be metle 24 hrs. in advance - phone 259•881 5. <br />2. All work ehall be perlormed In eccordance with ihis permit entl current City of Everett Design and Conslructlon <br />Stentlaidn end Specifltellons <br />3. Call Location Underground Servlce 48 hre. belo�e you dig. TOLL FREE NUMBER 1•800•424-5555. <br />�r/6'GiG Grh�.c°,f_c %�F/.'.�,iT /�L' .rc�U�,E'F� <br />� Approved lor Cons�ructlon <br />FINAL INSPECTION <br />Approved as Constructed <br />everet� PUBLIC WOFKS DEPAH'i P7ENT <br />� 3200 Cedar btraet <br />Everelt. WA 98201 <br />Phone:253•8815 <br />Date <br />Date <br />/, <br />/ �'�!xU <br />IU�/J/5'N <br />idGzl <br />W <br />H <br />� <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The under�i�ned owner/epplicenl he�eby agrees to tiold end seve herm• <br />less the Gity ol Everett I�om eny and all claims lor demapes. cost& <br />eapenses. �•r ceuses ot ection thet may eriee beceuse ol Instellatlon <br />;�ntl meinte,�ance of Ihe improvamenl or other right�of-wey use harelo <br />applied iur and lurther agrees to �emove seme upon notica hom ihe <br />City end to replece public property den.eged thareby. <br />Signalure ol Applicant Dete <br />WORK AUTHORIZED BV THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PEHMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BV THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURA?ION. <br />