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�- <br />�� <br />Datos ����� <br />Appllcation For <br />PUBLIC W�GRKS PERIVIIT <br />Print or Type Only <br />Public '�lorke Perml� ♦ <br />Blep. Dno�. �� C <br />Public Worka Feo <br />Total Foo �� <br />�eea FOOIjOo Pnitl S <br />BalantoDue S <br />��� • � .�jfTc� u��= =� J �/�'l/'.Cv.s:i7�=: ri . <br />,�marirnn lcr N,tinnal 6�nk G923 Everareen lday ���%�9 ����``"��- <br />Owner Malling Address City Zip Phone <br />Cnhra Cn^struetion PO Box 1299 rverett ldA 93706 258-3667 <br />Applicant Mailing Address Cily Zip F�one <br />Describe Proposed Work //!�S' / /�%« ����� _ -�-�GrT / �'� 5` �/c`]f. C.c���c-/` ' <br />r, n% c=!/<Z%i G��r=.J u/fJv �,Cv�J� i9Ge-"_ i�.�'�'v�7"i=; d�' � <br />- - - - � � <br />Project Address (if known) <br />Attach four �4) copies ol plans for proposed work • Draw to scale and note ihe tollowing as applicable: <br />• Proper�y Lines • Cen�erline of slreel <br />• Oulline and dimensions ol all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed uti�ities • Show measurements <br />PERMIT CONDITIONS <br />7. All calle for inspection shall be made 24 hrs. in advance - phone 259-881 5. <br />2. All work shall 6s performed in accordance with this permit and current City ol Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />�/ ,o,�i a,� i� o c�u�F'rJ cr, f���'-z<r.,'-� : �J/G G_ <br />; aj�'o d/�OC �� dic � �J Gi�J� � ,� .J�•9/eLi f�.0 �� � <br />a'S/Gn� f�i'd�v!/�5'L �foiJsT.�'ci��T �'Ci.�'� ��uTTc-�-�' <br />S/ t9 c�-�/t7L,� c i'�I c v: 'l'G,C'c�=� �� c �9'�j �/'`•rnJTi?Gc= _� <br />; �;<:'`;t'� w' /7S ; <br />SC/ G <br />FINAL INSPECTION Date <br />Approved as Constructed <br />. everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Stroet <br />Everett, WA 98207 <br />Phone:259-8815 <br />Z. <br />OI <br />ACKNOWLEDGEMENT CF CONDITIONS <br />The undersigned owner/applicant hereby agrees lo 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 ari;e because of installation <br />and maintenance of the improvement or other right-obway use hereto <br />applie��r�and lurther agrees ;o rer�ove same upon notice Irom the <br />City a�f��replace public property demaged lhereby. <br />� f <br />�_—^`". <br />�. --,\.:�'— .. f. ..e :../�� �-•i�'" D�4� <br />WORK AUTHORI2ED B�'f/-fIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND TFIEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COAIPLETION. THIS PERMIT MAY BE <br />CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 50 DAYS DURATION. <br />�.� <br />