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Date��n s` <br />ri <br />PUF�"LIC <br />O <br />O <br />Print or Type Only� <br />ni <br />M <br />Application For <br />WORKS PERMIT <br />O O <br />O M <br />w en <br />rU � Mailing <br />F' w <br />x <br />c//� %�y/� / <br />Public Woikf Mermit �^/ D��`� / <br />BItlg.Depl.+ <br />Pu�lic Works Feo $ <br />Taial Fee <br />Less npP� Fee PaiA $ <br />.3 � ���� <br />galance Uun $ <br />�Dz- �zz - yo -000-�.�-��, <br />Zip Phone <br />� �:`�� i� ii i� I/ <br />S'a.�. <br />Applicant Mailing Address City Zip Phone <br />Describe Prc '•sed Work <br />Project Address (if known) �� � u � � •+T �- � � � T ,r �v 4 <br />Attach four (4) copies of plans lor proposed work - Draw to scale and note ihe following as applicable: <br />• Properly Lines <br />• Outline and dimensions of all existing and <br />proposed siructure; on the lot <br />• Existing and proposed utilities <br />• Centerline ot streel <br />• Indicate North <br />• Show any proposed grading changes <br />• St�ow measurements <br />PERMIT CONDITIONS <br />1. All calis for inspection shall be made 24 hrs. in advence • phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current City of 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 />y GVD7lu .�O C� d�— �y ��,U��Z�-�/" ' J.2��.,.� <br />da,�al �a-��-�o _ <br />��j / /+�, /� /�- /�/ ,[� <br />"'� .�[CJ.PLJ6L!�"✓� �'U.hlJ �%C,'LLG(Yz .Sf%!1� /� /�F� �G.il': <br />�g<n�� Cc�z� CtG�,�,o���to' �3oS ��" �37i6 l��r*s z�, <br />FINAL INSPI <br />Approved as <br />everett <br />e <br />/��/� � Co7,.,-LGa.z�cO,.,-l� �7»<...cLi�.•. <br />l /�/Ii.C�rL < �yCi <br />✓ <br />PUBLIC WORKS DEPARTMENT <br />3200 CeJar Street <br />EveretL WA 98207 <br />Phane:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />O <br />The undersigned owner/applicanl hereby agrees to hold and save harm- <br />less the City o( Everetl from any and all claims (or damages, costs, <br />expenses, or causes ol action that may arise because of installation <br />� �` �G and maintenance ol the improvemenl or other right�o(-way use hereto <br />applied for and turther ac�rees to remove same upon notice Irom tl�e <br />Dale City and to replace public property damaged thereby. <br />� � G � <br />Signature ot Applicant ate <br />WORK AUTHORIZED BY TH PERMIT MUST BE STARTED lh'IiHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEHEAFTER IS TO <br />BE DILIGENTIY PURSUED TO COMPLETION. THIS PFRMIT MAY BG <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF NlORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />