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T- <br />.:, <br />;� - <br />Date <br />Appilcatlon For <br />PUBLIC WORKS PERMlT <br />Pr?nt or Type Only <br />�� <br />Pu�IIc Wo�ks Pe�mll + ' � ! �'�' <br />emo oeo� • <br />Public Woeke Fae � 5S. �t.' <br />Tatal Foe $ <br />Le6e Appl Fee PnIC S G <br />Balnnco0o0 � /�/• ��� <br />,:—'�. � Jt'"f�/ <br />Ci�►'� !f% N/rT /3/P/Vk G4Z,Q �YRC�KN W� £YT y',pzo/ <br />Own:r MailingAddress City Zip Phone <br />Co✓��2�! Cv++�sT p0 BoK �z49 EvT FF�oy .�.58-3GG? <br />Applicant MailingAddress Ciry 2ip Phone <br />Describe Proposed Work in s7' C N� G�tTTSZ � S, wiy�.,�c �..,, � vfatG,p,v �v� r7�vNTilt,, E <br />Project Address (if known) <br />Attach four (4) copies of plans lor proposed work - Draw to scale and note the following as applicable: <br />• Properly Lines • Centedine ol sireet <br />• Outline and dimensions of all ezisting and • Indicate Norih <br />proposed structures on the lot • Show any proposed giading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance • phone 259•881 5. <br />2. All �vork shall be performed in accordance with this permit and current Cily of Everett Design and Construction <br />Standard, and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />/!J �F '; • ; � i , <br />i/�ii.� i i�� �, . � <br />li4T.F�l� 7�'i .=% <br />.'i_' %�-�f' <br />'_'�„= � l ' � �'7-l' : � %/ /`- `�lC <br />Approve for Constr4ction Date <br />�� FINAL INSP�CTION / <br />Approved as Conslructed \ <br />everett PUBLIC WORKS D <br />� 3200 Cedar Street <br />Everetl, WA 98201 <br />Phone: 259-887 5 <br />i��o// <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />■ <br />� <br />I•\ <br />U <br />r <br />V/ <br />O <br />a <br />The unoersigned owner/applicant hereby agrees to hold and save harm- <br />less the City oF Everett Irom any and all claims for damages, cosis, <br />expenses, or causes of aclion that may arise because of installation <br />and ma�i len nce ol the improvement or other right-ol-way use hereto <br />appJ��/�or��nd further agrees to remove same upon notice from the <br />Cit(� add-t6replace oublic property <jar�9ged thereby. <br />� nature of A� I�iE � 170te <br />WORK AUTHORIZE BY . PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISS ED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TU COMPLETION. THiS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 50 DAYS DURATION. <br />� «4 <br />�� <br />