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��y <br />,o�x <br />9Ht~A <br />1yC � C'] <br />H� <br />� N'� <br />ti1 yoy � <br />'� <br />ON� <br />��g <br />Q Y (7 <br />t" y � <br />NH <br />N <br />g�� <br />�HN <br />HOV� <br />� ' � <br />n. ..M . . . . _ <br />� <br />DateJ_LL_(sJJ <br />App�ication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Applican� <br />Describe Proposed Work <br />r��� i v ux oo� i <br />Mailing Address <br />�,.�n ��I21- ItiS�h <br />Mailinq Address <br />� cmc� <br />� 4 <br />_ .. . - _ . _ _ _ _ __ _ _ _ .. . _ _ _ . . .I <br />� <br />Publ¢ WorFs PcD�mi,l �• <br />Ni�f� Dept � �(/��� <br />Ponbr, worxs Fca s <br />Tol.tl Fee <br />Less Pppl Fec PaN $ I t <br />Baiance0uc S � <br />uk�lfeo 9�27� 353-2v�18 <br />City Zip Phone <br />_ n 1!_' G._ ,. �007n 2�i1 �70a i � . <br />Projecl Address (il known) � v" • • ` `�'+ — <br />Atlach tour (4) cop�es of plans lor proposed work - D�aw to scale and note ihe lollowing as appllcable: <br />• Property Lines • Centerline ot sireel <br />• Outline and dimensions ol all existing antl • Indicate Norlh <br />proposed slruclures on ihe lot • Show any proposetl gratling changes <br />• Enisting and proposed utililies • Show measuremeNs <br />PERMITCONDITIONS <br />1. All calls for inspection shall be ma�e 24 hrs. in advance - phone 259•8870. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Consiruction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLI FREE NUMBER 1•800-424-5555. <br />��,l�<-.i ..'Ja;_/� �C'.si.�..�:.....:/,,c7`,� �r=n. ,� <br />� <br />.:�:f �c:� f.�� <br />J /7 �� <br />Approved for Construction Date <br />FINAL INSPECTION <br />Approved as Cons�ructed <br />everett PUBLIC WOAKS �EPARTMENT <br />� 3200CedarStreet <br />Everett, WA 98201 <br />Phone:259�8810 <br />Date <br />� <br />O <br />,�A <br />V♦ <br />� <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersi9ned owner/applicant hereUy agrees to hold antl save harm� <br />less the City ot Everett Irom any and all claims lor dama9es, costs. <br />ezpenses, or causes of aclion thal may arise because ot installation <br />and maintenance ol lhe improvement or o�her ri9h4of�waY use hereto <br />applied tor and IuAher agrees to remove same upon notice Irom the <br />City antl to rep�ace public property damaged ihereby. <br />Signature ol Applicant uaie <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATL PERMIT IS ISSUED ANO THEREAFTER IS TO <br />BE DILIG[NTLY PURSUED TO COMPLETION. THIS PEFiMIT MAY 8E <br />CANCFLLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />