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L^ <br />1 <br />��� <br />>H <br />>ycHn <br />y �H <br />fC C] <br />H x1 <br />"�b H'il <br />(q H <br />� O� <br />HG <br />��g <br />4] Y � <br />zyy� <br />rHH <br />gy <br />N <br />C] t7 y <br />��� <br />H O fyA <br />' . <br />Date. C��� <br />S�/,.�,D '^-�/-' % I2II0-UU <br />� <br />Applicalion For <br />RUBLI� WORKS �EFiMI �' <br />Print or Type Only <br />PUMm V/crMs Permit • �� � � <br />HIa9 Dc01 • �� _ <br />Publ�c wo�xe Fce 5 <br />Total Fec <br />Less AOG�. Fee Paia S O <br />'�, Balance0ue 5 ��� <br />00� -.3.?z - �o -oan- i/-83i <br />�n� � I 111 � 6�� �1 Ul/f 1 �i/1 � a %�P.�' G1�"ob� �g - ? r� <br />n...r,���� MailinaAddress City Zip Phone <br />Oescribe Proposed Work <br />Pwiect Address (il known) <br />Atlach lour (4) copies ol plans for propo��ed work - Draw to scale and nole Ihe lollowinc�`�+� aonlic�ble: <br />• Property Lines • Centedine ol street <br />• Outline and dimensions ol all e�isting and • Indicate North <br />proposed 5trucW res on the lot • Show any proposed gradin� changes <br />• Existing and proposed utilities • Show measi•remenls <br />, PERMIT CONDITIONS <br />7. All calls tor inspec�ion shall be made 24 hrs. in advance • phone 259•8810. <br />4�' � 2, All �vork shall be pedormed in accordance with this permit and current Ci�y ot Everelt Desi9n and Constmc�ion <br />� � Standards and Specilications. <br />3. Call Location Und=rground Service 48 hrs. before you dig. TOLL FREE NUMBEfl 1-800�424-5555. <br />'M w <br />� �� <br />��. �. <br />... � <br />�q� � <br />S�w���� ,�P� <br />f�d,�- da�l 9 �2-8a ' ���c.f%�> <br />FINAL INSPEGTION <br />Approved as Constructed <br />everett PUBLIG WORKS DEPARTMENT <br />� 3200CedarS�reel <br />Everelt, WA 98201 <br />Phone 259-8810 <br />� <br />Date <br />Z� <br />O <br />ACKNOWLEDGEMENT OF CONDITIO�JS <br />The undersigned owner/applicanl hcreby a9rees to hold o��d save harm- <br />less ihe City of Everett irom any and all claims lor damac�es, costs. <br />expenses. or causes ol action thit may arise because ot inslallation <br />and maintenance ol Ihe improvement or other ngh4of-way use hereto <br />applied for and Iwiher a9rees to reicove same upon notice irom the <br />Ciry and iq replace pubGc O�o�lerty dama9ed thel.opy. <br />�o«S� <br />�i 1 �e ol App�icant � � Date <br />�K AUTHORIZED BY THIS P�RMIT MUST BE STARTED WITIiIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEfiEAFTER IS TO <br />BE DII.IGENTLY PURSUED TO COMPLETION. THIS PERMIT M11AY BE <br />CNNGELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />R�. ' <br />