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Date � f/.�8 <br />� Applicalion For <br />PUBLIC WORKS PERMOT <br />Print or Type Only <br />Pu�liclJo�ksPormil• ��—�G � <br />BIJO� DoO�� � <br />PuUI�cWorheFea § <br />Totel Fee <br />Less AppL Foo Paia 5 <br />BalancnDue 5 �OC+�9'e�� <br />�c,XX�� �.or� P/�� "� l� � S � �2, l:.�C��1R-� ll.��� �C�-l;Tl . �J/� � <br />Owner MaOiny Address Cily Lp Phone <br />J�+..� r1a�2��s�,� y� �3�`�-l�C�a:rJ � l-��tz.E-1i��� IaG,�2�t'i MiN��2. a��.�S�,�wo . <br />qpplican�~ MailinqAtldress City '� 2ip �� Phone <br />S�- �- �} O �J-�' <br />Descrihe Proposed work C � "�L-�' � ��"� � -�"��� ����� ( � , - �11 � � 1 _fl 1, <br />ProjectAddrass(if known) rJ�"Z �����"��~J �'`'��� ����"���' �� � <br />Atlach four (41 copies of plans lo� proposed work - Draw to scale and note the following as applicable: <br />• Property Lines • Centerline :+t street <br />• Uutline and dimensions ot all existing and • Indicate North <br />proposed structures on Ihe lot s Show any proposed grading clianges <br />• Ezisting and proposed utilities • Shew measurements <br />PERD!i"CONDITIONS <br />:. All cal's for inspection shall be made 24 hrs. In advance • phone 259•8810. <br />2. All woik sha�l be pedormed in accordance with this permil and curre��.' Ciry of Everelt Design and Construclion <br />Stand:.rds and Specifications. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� �� �� �w� � � d� ,� ..� ��.�� �30 � <br />s �w� .� /� �, � �. �c.�.�.�.o� �Oa�� �„t <br />� s� ,�` <br />6 . G.�� � �. �.�..e �,. �ti.�.� s,E�,6 <br />� fS' �Jgd''%Y�(rc'/�s'K/? <br />�� _ .( _ _...... <br />—��'��'� �//8a <br />Approve o onstruction � Date � <br />. <br />LGc— ��= ��r�� � �%/p� <br />FINAL INSPECTION a�e <br />Approved as Constructed <br />everett PUBLIC WOf;K5 DEPARTMENT <br />� 3200 Cedar Slreet <br />Everett, WA 98201 <br />Phone: 259•8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />� <br />The undersigned owner/auP��cant hereby agrees to hold and �ave harm� <br />less the Cily of Everett irom any and afl claims lor damages, costs, <br />enpenses, or causes of aclion that may arise hecau�e ol installalion <br />and maintenance ol Ihe improvemcrt or o�her right-oi-way use hereto <br />applied tor and lurther agrees to remove same upon nolice from the <br />City and 1� replace public Uroperfy damaged thereby. <br />-Z-�X <br />l'JO� AUTHORIZED 8Y THIS PERMIT MUST �E STARTEO WITH!N <br />1c DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE UILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 UAYS DURATION. <br />