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r <br />Date 4 �'3 • <br />Applicetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />PUEhc WorAa Pe�mil � �Y.�-- <br />Bldp. Depl. • <br />PubllcWorluFee : �� � <br />Tot�l Fes <br />Lees Appl Fse P�Id S�-- <br />s 7-0_ �� <br />p�lanca Due <br />-1 <br />Ad�� Go-raf� �-.�� G.:�,n 5-a�c-- <br />Describe Proposed Work � �_�__�— <br />Proleot Address (if knpwn) <br />Attach four (4) copies ot Dlans for proposed viork - Draw to scele and note � Ceoterline of sheeii able: <br />• PropeAY ���e8 • Indicale North <br />• Outline and dimenslons of all existing end � ghow any Proposed grading changes <br />proposed structures on the lot � Show measuremenle <br />• Ezislinq and proposed utilities <br />DO NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />1. All calls for Inapection shall be made 24 hra in advance - phone 259•881 5. <br />2. All work ahell be performed in accordance with this permit and a�rrent Ciq� oi Everett Design and Construction <br />Standerds end Specificetions. <br />;t. Call Locatlon Underground Service 48 hrs. before you dig. TOLI FREE NUMBER 1'800'424•555 . <br />-�-����,�� �-.����y <br />Approved tor Construchon <br />Date <br />Date <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everett, WA 98201 <br />Phone: 259-8815 <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims �or damages, costs. <br />ezpenses, or causes of action thal may arise oecause of installation <br />and maintenan,:e oF the improvement or other righhof-way use hereto <br />Citylland'�o eplace publ c9peopertYrdamaged hereby.n notice from the <br />gTgnature of Applicant <br />JJpRK AUTHOHIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERIv11T IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PEFMIT MAY BE <br />PqOJECT OVER 90 DAYS DURAT ON. STOPPAGE OF WORK UN TFII3 <br />z <br />0 <br />� <br />., <br />n <br />m <br />H ti <br />""1 � <br />F�1 �"� <br />N 2 <br />m <br />0 <br />m� <br />om <br />-1 z <br />m� <br />.. <br />c <br />rD- i <br />... .. <br />< N <br />� <br />oa <br />� � <br />� m <br />x <br />m �-. <br />N <br />3 lyn <br />z c� <br />�r <br />m <br />a <br />z <br />-� <br />x <br />a <br />z <br />1 <br />x <br />.. <br />N <br />Z <br />O <br />� <br />� <br />m <br />