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i' <br />Date � /�� <br />Appllcatfon For <br />PU�L�C WORKS PERMIi <br />Print or Type Only <br />C.,4�4A�7CGL- FL�=v� y <br />Owner Mailmg A dres <br />�,t��n�, �.a�kl.�.�f /�'as� <br />i.pplicant Mailing Addres <br />Describe Proposed Work <br />�VI �►-X • !1 � r'. . <br />.:.��j� �, <br />Project Address (i( known) `S' `' ��'�'� <br />Atlach four (4) copies of plans for proposed work • Draw <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed siruclures on the lot <br />• Existing and proposed utilities <br />0o r <br />PERMIT CONDITIONS <br />� <br />-------- - - <br />' 3 <br />Public Wo�ke Peinli r �� /� <br />ema. oec�. _ <br />PUEIicWorkaFeo �'� <br />Talel Fee S <br />Lass A00� Fee PeIE S <br />Balance Due S � <br />.Se�-7TL t yb�/a <br />and <br />City <br />Zip <br />Zip <br />the (ollowing as applicable: <br />• Centerline ot street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />� 77a� <br />' j-/ S3 <br />Phone <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•881 5. <br />2. All work shall be periormed in accordance with this permit and current Cily ot Everett Design and Construction <br />St2ndards and Specificationa <br />3. Call Locatiun U/ndergrou d Service 48 rs. before you 1dig. �Tc,O/LL FREE N BE�R 1-J$Q 0•424-555/5�. <br />�, �/ S "'� `S��% /` �GY S s[ / / �-�- SO [.i�'-�'Y� �� �C..P� <br />�_l�s�/� �- �'ar�� �ui� � � �«l�c ./�f of' <br />STraccr /1/c/�G� //!%/1QtL/R��ly cf't-i�-t�r !01''���/`/F�" e� <br />/ <br />�raa'i'��%. <br />� / <br />�. /�J J`/oytu ( �Gro.�o 1� ��"! �m � /�6eSv r P5 <br />r�e �,'r�� Q/ �`�- C�'� -�u��-_ ���' <br />Cdyld. �/Ovc� c?���-P ►�� r�t � d r�rn S�ur� � S <br />lv . ,�/T�fi� /�^�/^.C�1G <br />,f�iJ/f�j•J o%J�sJ <br />� <br />FINAL INSPECTION � J� <br />Approved as Conslructed LJ <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl, WA 98201 <br />Phone:259�8815 <br />�_�-- �,`��_ "'�l� <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />Z <br />�s3 � <br />� <br />m <br />W <br />� <br />� <br />� <br />� <br />� <br />h�w <br />� v <br />O <br />a <br />The undersigneJ owner/applicant hereby agrees to hold and save harm� <br />less the Ciry of Everett from any and zll claims lor damages, costs, <br />expense:,, or causes of action that may arise because of installation <br />and maintenance of ihe :mprovement or cther righl-ol•way use hereto <br />applied (or and lurther agrees to remove same upon notice (rom the <br />City and t�replace public property damaged thereby. <br />� � <br />� YI�-rM � f �'��/ � �.. . <br />Sign ture of Applican ate <br />WORK AUTHORIZED BY THIS PERMIT MUST E STARTED WITHIN <br />180 DAYS OF DATE PERh71T IS ISSUED hND THEAEAFTER IS TO <br />BE DILIGENTLY PURSUED TO CO(�1PLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE C�TY UPON ANY STOPPAGE OF WORK ON TF11S <br />PROJECT OVER 50 D aYS DURATION. <br />� <br />�. .. <br />�� <br />.. --1 <br />�_ <br />v <br />m <br />co <br />m� <br />--� � <br />O 3 <br />m <br />_ -�i <br />m <br />A 2 <br />c <br />�i <br />—I N <br />� <br />T <br />o� <br />-n a <br />3 <br />—i m <br />x <br />m �-+ <br />N <br />or <br />c� m <br />3 fn <br />Z C� <br />.i m <br />a <br />p <br />� <br />2 <br />a <br />z <br />� <br />.-_. <br />N <br />z <br />0 <br />� <br />� <br />m <br />