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Date� �� � �j <br />ApDlicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />If�:u'�.n,i f�ildr�,.,y <br />�/,(�` � — _ <br />Appiicant �,m , r,�i����.,��, <br />De.�scribe Proposed Work <br />Proiect Add�ess (d known) <br />v�m�c wons �rrnn . <br />oin9 Dro1 . _�I` —�'�OC�Il.i[7 <br />Pubnc worY.a Fec S -- � <br />TalsiFee <br />LPSSA001 fPpP1b4 � <br />Beiance Uue S <br />�� � �_%��'� ` =��U G u �'L�l� <br />I;dq lip Phonq <br />- �. � , -- --1-� — -- r��,o�,�� <br />Attach lour 141 copies of plans fOr proposed work � Oiar+ to scale anA note the lollowing as apPiicable. <br />• Propeny lines • Centerline of sfreet <br />• Outhne and dimensions of au ex�stmg and • Indicate North <br />P�onosed strur.tures on Ihc lot • Show any proposed gradin{� chanyes <br />• Ezisting and propos�d ulilities • Show measuremenls <br />OW THIS LIN <br />PFR�dIT CONOITION� <br />1. Ali calls lor inspeclion shall be made 24 hrs. in advance - phone 259-8810. <br />2 Ail work sh211 be performed in accordance wilh Ihis permil and current City ot Everett Design and Constiucl�on <br />Standards and Specilicatiens. <br />3. Call Localicn Undcrground Seivice ��ti hi-s. befoie you din. TOLL FREE NUMBER 1•800•424•5555. <br />�J�L!c�, lcJ<i'.:,. f : t:,.< :' �� � It ;�t y.t:�. �r�. G 9/L �3�0� /-y� <br />6 '�'—�/J� <br />y _2/ -�/ <br />��-(�( �%'L4��Q <br />,�`��d� wQ,�. <br />u.,�.�.� w,�...rf ,� <br />�i74Sc✓ CtJ4.C�+� C'mv�+.e���^' f�cu^c .-�ite•.,✓ <br />;�� ��.u. <br />AI;Im:vr+l li r Cur���bu�.L�;n �� � <br />FINAL INSPECTION <br />F�pprovcd as Con5lructed <br />evrmtt PUf3UC WORKS DE <br />� 3200 Cedar Sl�eet <br />[verriL WA 98201 <br />Pner�• �"+'���'��1 <br />��,� .t.��:, o-�; �- . <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />Y/ <br />0 <br />a <br />ACKNOWlEOGEM[NT OF CONDITIONS <br />The undersigned owner/app6cant hereUy ayrees to hoid and save harm� <br />less lhe Ci�y of Everetl Irom any and all claims for damages. cos�c, <br />expenses, or causes ol action Ihat may arise because of installalion <br />and mainlena�ce of Ihe improvement or other right�ol-way use hereto <br />apphed for and further agrees lo remove same upon notice from the <br />City and to replace public property damaged Ihereby. <br />Signa�ure of Applicanl Dale <br />WORK AUTHORIZED BV THIS PERMIT MUST BE STARTGD WITHIM <br />180 DAVS OF DATE PERMIT IS ISSUED AND TNEREAFiER IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION THIS PERMIT MAY B[ <br />CANGELL[D BV THE CITY UPON ANV S7'OPPAGC- Of WORK GN THiS <br />PHDJECT OVER 90 DAVS 6URATION. <br />