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Date_�j�1� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />r�er�won�.v n. <br />B�Up. DeW. e <br />r�m�� woa. vae <br />TMei Fae t <br />Leee AoO� Fee Ga�E S <br />Balence Due <br />Applicant <br />I �'l.l /�/D <br />iling Adtlress <br />Describe Proposed Work ��KL_F-�'v � l /+/��iE ('Y / <br />Prolect Address (if known) <br />Attach lour 14) copies of plans for proposed work - Draw to scale and note the following as applicab�e: <br />• Proparty L?nes • Centerline of street <br />• Outline and dimensions ol all existing and • Indicate North <br />propoaed structu.es on the lot • Show any p�oposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be pertormed in accordance with this permit and cur�ent City oi Everett DeEign and Construction <br />Standards and Specilications. <br />3. Cell Location Unde�ground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-55$$. <br />/�i�C% �C%iC� lz��%c�s % c-�''i�'iT / l r;,� ;/E�� <br />7� � <br />`'�/�/ .% �'. f.�i ��/�,� ; <br />� <br />Appioved for Consfruction Oete <br />FINAL INSPEC710N Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar S�reet <br />Everett. WA 98201 <br />Phone: 259-BB 7 5 <br />AGKNOWLEDG[MEIJT OF CONDITIONS <br />W <br />� <br />� <br />The undersigned owner/applicant hereby agrees te hold and save ha�m� <br />less ihe City of Everett Irom any and all claims for damages, cosis, <br />expenses, or causes ol acfion tha� may arise because ol instaltation <br />and maintenance of the improvemenl or other right-ol-way use heretp <br />epplied for and lurther agrees to remove same upon notice Irom the <br />City and to replace public property damaged ihereby. <br />Signature o� Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1�0 DAYS OF DAT[ PEFMIT IS ISSUED AND THEH[AFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS F'ERMIT MAY BE <br />GANCELLED BY THE CITV UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />2 <br />O <br />-�1 <br />n <br />m <br />-i r <br />.. .-� <br />N S <br />m <br />co <br />mo <br />o� <br />-� z <br />2 --7 <br />m <br />o z <br />�i <br />... .. <br />�� <br />< <br />� <br />O � <br />-� m <br />m � <br />w <br />or <br />c� m <br />3� <br />m <br />�m <br />A <br />S <br />a <br />z <br />-� <br />x <br />� <br />z <br />0 <br />� <br />� <br />m <br />