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Date�.�d�� ^ <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />��LO�C"f: S <br />Address <br />c�E�o,�/���'-�nl j <br />Mailing Address <br />Describe Proposed Work <br />PuClic Kb�ks Permll�(P. <br />BItlB� Ocpt s _C A �� � <br />Pu01ic Works Fee <br />Tot.l Foe S — <br />1e55 A00�- Feo Paid S_ <br />Bolante Ouo .S _ <br />f'hone <br />�? �,`� --6��3/ <br />Phone z <br />0 <br />-i <br />.-. <br />J� y , �� m <br />Project Address (if known� � — - — - <br />Attach four (4) copies of plans for proposed work • Orew to scale and note the lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed siructures on lhe lot <br />• Existing and proposed utilities <br />• Cente•'ine of street <br />• Indicale Nor�h <br />• Show any proposed grading changes <br />• 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 performed in accordance with this permit and current Ciry of Everetl Design and Conatruction <br />Slandards and Speci(ications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />i%��l�B��� t�/�,e�s� ��2.��T <br />G <br />Approved for Consiruclion <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />� Evere�t, WA 98207 <br />Phone: 259-8815 <br />�'�Cj L�/.���i <br />�f� �Z/��� '�%'� <br />�/`' ( <br />ACKNOW�EDGEMGNT OF CONDITIONS <br />� <br />L J <br />� <br />� <br />� <br />a <br />The undersiqned owner/applican� h�reby agrees to huld and save harm- <br />less ihe City ot EvereU from a.iy and all claims for damages, costs, <br />expenses, or causes of action that may arise because ot installation <br />and maintenance of �he imprcvement or other righ4ohway use hereto <br />applied for and !urther agrer.s to remove same upon notice Irom the <br />City and to replace public pr�periy damaged ihereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED fjY THIS PERMIT MUST BE STARTED WITHIN <br />78C' DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE iiILIGENTLY PUPSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THF CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUFATION. <br />.. .. <br />--i �t <br />.� � <br />Nm <br />v <br />co <br />mo <br />-� c <br />om <br />_ -�I <br />m <br />oz <br />a -i <br />rx <br />.� .. <br />�--� N <br />� <br />'�7 <br />o� <br />�a <br />-� m <br />x <br />m� <br />N <br />0 <br />or <br />c-� m <br />c �n <br />3 (n <br />m <br />Z� <br />�m <br />a <br />� <br />� <br />_ <br />n <br />z <br />� <br />� <br />N <br />Z <br />0 <br />� <br />.... <br />n <br />m <br />� <br />