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Dat ���� <br />qpplication For <br />PUBLIL, WORKS F'ERMIT <br />Print or Type Only <br />��2 � <br />Owner <br />ress <br />Vubhc Wo�Ms Pnrmit o �� <br />f3ltla ocnt a � � <br />Puohc works F�c S <br />TOITI FCa <br />LessApP� Foa Poitl S � <br />onlanco ouo � <br />��5�'O�G <br />Phone <br />t1G� F'IU�1_U�'�4 �`-� IEa� �..N�-�llt7� `t'g�(22 '��5-2553 <br />Applicant Mailing Address C ty Zip Phone <br />�O �i �-I F'I�R�O1 � <br />Describe Proposed Work �-aJ���� nF ��-- `�'{�Pf'--- — <br />Projecl Address (i� Mnown) <br />%8/S- E�iiE.ec <br />Atlach four (4) copies of plans for proposed work - Draw �o scale and note the lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions ol all existing and <br />p�oposed slructures on ihe lot <br />• Exisling and {?roposed ulililies <br />• Centerline ot sireet <br />f Indicate North <br />• Show any proposed grading changes <br />O Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor ir,spection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and curreid City of Everetl Design and ConsVuction <br />Standards and Specilications. <br />3. Call Localion Underground Service 48 hrs. belore you dig. TOLL FREE NU�9BER 1•800•424•5555. <br />� % BE' co,�s,-i�vc: �o .�E%2 .9�;�F_>��� c� <br />�'H,✓S vBTE'v s=� -6'G <br />���'�� �-/�/8� <br />ApProved for Const ction Date <br />Y G l� <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Ceaar Street <br />EveretL WA 9820' <br />Phone:253-BB75 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />LJ <br />The undersi9ned owner/applicant hcreby agrees to hold and save harm� <br />Iess the City of Evere�t Irom any and all claims 1or damages, costs. <br />expenses, or causes ol acPon that may arise because of installa�ion <br />and mainlenance ol the improvemenl or o�her righhot�way use herelo <br />applied for and further agrees lo remove same upon notice from �he <br />City and lo re blic properry damaged lhereby. <br />Signature i ant � Date <br />WORf AUTHORIZED BY TI�-1 PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTEF2 IS TO <br />BE DILIGENTLY PURSUED TO COM1IPL[TION. �HIS PERMIT MAY B� <br />CANCELLED BY 7HE CITY UPOP! ANY STOPPAi9E OF \�JORK ON THIS <br />PROJEGT OVER 90 �AYS DURATION. <br />