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Date L- $- S5 <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Public Works Permit a L�,��s�--� <br />Bldg. Dept. er_/ZW 290 <br />Public Work. Fee <br />Total Fee S <br />Less AppL Fee Paid S <br />Balance Due <br />SQNILAry <br />JONN 19`16o FRRACE <br />SNny( rS 9829,E <br />_%9_59Qq <br />Or nee r <br />Malting Address <br />City Zip <br />Phone <br />1)esscLTr_NE <br />JIM PO (015 <br />SNnNnMt4/ 98290 <br />5&F- qT / <br />Applicant <br />Mailing Address <br />City Zip <br />Phone <br />Describe Proposed Work NP-W 0 O N_S%R 4f C rI ON ` /) U PfE X <br />Project Address (if known) ✓ v i .6-1 <br />i <br />Attach four (4) copies of plans for proposed work- Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot - • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259.8815. <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 />22Z1t1C-,,a 76) DE•/J/CaTE .S bF AAO/ 7;i4,IV4 L <br />%(BHT-Oi Lt//Iy AGOA1b THE E4S7- S/dam OF <br />`LE/n/•t/(r S7: C•iry "le SS"5-.78- <br />S. �eo.✓r f/.It 0 S�> - s3a Coe- S.sd Le SE <br />A A'.fi/fT — <br />for <br />pF_ kl dl G/N6 - <br />61 <br />FINAL INSPECTION O <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />z <br />0 <br />0 <br />am <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 for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-of-way use hereto <br />V applied for and further agrees to remove same upon notice from the <br />Date City and to replace public property damaged thereby. <br />Date <br />Si n ture of pplicant Da e <br />WO K AUT ORIZED BY THIS PERMI IJST BE STARTED WITHIN <br />1B DAY OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />B DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />0 <br />c-T <br />17 <br />N rn <br />0 <br />rn <br />co <br />m nor <br />o <br />m <br />r S <br />F-1 M <br />< N <br />s <br />oz <br />In �Pc <br />—1 m <br />rn <br />mN <br />or <br />n m <br />c N <br />3 N <br />m <br />z r--r <br />�r <br />• m <br />z <br />