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� 9 � <br />Date � �� v <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />,�h;i mcA/, <br />Owner <br />��ti , �� /1'7'e /� l,.'s s <br />Describe Proposed Work � <br />�5'cs,�� 2 L- �ic- <br />` f/!L oN LoT <br />TL /2 ��.3U CyAc�L� <br />' Mailing Address <br />� <br />Maiting Address <br />� )i= �-l�PF ��U%T.��( <br />2� ���2� <br />c��Y <br />City <br />/'W �VE <br />.=._ i a,t' S�5 <br />Publrc Wodg Permu � %p _ `� `� -� <br />eie9. oeo��+ <br />Pu�hc Works Fee s <br />Total Feo <br />lesS ADp�� Fee Pel� $ �� �p <br />Balance Due S <br />O1�2 -3'lZ - �/D-C�0!' `/8 -83I <br />;� 9���,� 3ss-S9�7 <br />C97 <br />prole��Address�ifknown) In�_,���� r � �"� <br />Attach four (4) copies of plans for proposed work • Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed siructures on the lot <br />• Ezisting and proposed utilities <br />�%� %'L <br />• Centerline ol sireet <br />• Indicate Norlh <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. AII calls lor inspectiun chall be made 24 hrs. in advance - phone 259-8810. <br />2. All wnrk shall be performed in accordance wilh this permit and current City of EvereU Design and Consiruction <br />Standards and Specifications. <br />3. Ca�l Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800-424•5555. <br />5! �/ �?o.a�� �r.�`'a.e, ('mu.�.� oz a�•�.c�Z`' .� �z`o 6� <br />�rrc�r.e,� -i� cu�i/'✓ �� �C'l.� <br />.s �,�t'`R C'!' .�� �-e,,.� ��,� �•Cw �e�J �P���°43AM OOOAq3Bb1 <br />Cj�,//ty�.P.c� � .iZ/�r/ �G� ���Pi l�/C?/� /�"�' GC%�d180t]61749 <br />� V �� DPT.20 333.� <br />6, i�� C�-� �h'-u�f 'n-r� .�C��.>� � C.y. GASH l33.00 <br />,�!��,� 9/� �� <br />Approved lor Consvuction > <br />� ' Date <br />j-' / <br />�Gcyl� //' L - S'� <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBL�C WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everetl, WA 982U1 <br />Phone: 259�BB70 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />0 <br />�' <br />� <br />� <br />a <br />Thc undersigned ownedapplicaN hereby agrees to hold and save harm- <br />less the Cily ol Everett Irom any and all claims for damages, costs. <br />expenses, or causes of aclion ihat may arise because of installation <br />and mainlenance of the improvement or other ric�ht-ol•way use hereto <br />applied lor and lurther agrees lo remove same upon notice irom the <br />Ciry and to replace public property damaged thereby. <br />,(����?�� ,c�.�,T"1 J%a��9d <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE 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 />