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�.� L, y�, � � <br />Date �Q-�S�O <br />qpplicationFor <br />PUBLIC WORKS PERMIT <br />Print or Type Only �� PO;p�I1VG_! �` r� <br />Owner <br />En�r�n�o <br />Describe Proposed Work <br />f 3(�2�^ /5� rN,St , S. <br />Addr2ss City <br />L <br />/ <br />90_ S� <br />Public Works Permit s <br />01tlp� Dept. • <br />Public Works Fee s <br />Tolal Fea <br />Less FOP�. Fea Pald $ <br />Balance Due % � � 7� �' <br />743 -4�05 <br />Phone <br />li7C. S$nS �Ad'e WASN, 8/vd. �lE KlRlC�-AI-�D U/A gb'033 82%-l3Od <br />Mailino Address `f''''�—�ZiP Phone <br />i <br />L1/1! � .i _o�� r7 a70� �c�j Ce/���0 <br />��"5r�d �o rji�c�%��.�o�s. <br />SEorrnY �«e,-� ��arF.P rv r.-,r�r� >>.�' s.�c �.�;�� �G�P�P.>�s <br />�s/�O/Jo��hr d� ' /i �1�__'u�=�-`— -- <br />ProjectAddress�ifknowrn ����--_.�=—�v�-��}=%'..'�C�:h' -- <br />Attach lour (d) �o��es ol plans lor propose� ..,=4 - braw to Rcnin nlld nole Ihu IUII�• ,�y{i�q ns °PPlicable: <br />� fi•�operly Lines � Ci•�••_ _'�1Pe of street <br />• Outline and dimensions of all existing and r ludicate Norih <br />proposed structures on ihe lot ! Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMITCONDITIONS <br />1. All cells for inspection shall be made 24 hrs. in advance - phone 259•881 O. <br />2. All work shall be performed in accordance with lhis permit an� currenl City uf Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•8W424•5555. <br />� 9 �G.'Yfi �C4 fL �f OCCU�4n c� LrJ/�� h 0/ (J� <br />/S.S'ue� !�i✓fil 4 G�li,i�n e�ne�zf.�r�4L 4yreemenf <br />is e.1�eCi�fec� 6�fi.rc'en f/e Ci7`y Qnd �`�� Disf�'�oT. <br />� �0/'rc� '�7 Cl� G7ori:.' �/� ,fJ�4nS Q��/'OVPd ci!/ �G'i'�^C(/ <br />PvL✓C:c Cvo�,�l' 0�7 /2-z7 y'o � � <br />, �a�� �. <br />FINAL INSPECTION j Date <br />Approved as Constructed / � <br />everett PUBLICWORKSDEPARTMEN,T/� hU ��j.U�' <br />� 3200CedarStreel /��L2�G�✓���� f��-- <br />Everett, WA 98201 <br />Phone:259•8810 �`%SO�C <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />0 <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />�nd maintenance of the improvement or other right-of-way use hereto <br />applied for and furiher agrees to remove same upon notice from the <br />City and to replace public property damaged ihereby. <br />� �. { <br />�ot a �l <br />(�[ � ,�,G��� N�w�1Co�. �� i - 3 - 9� <br />Sign�e o( Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST 6E a"TARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPOPJ ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />