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Date � �'-� �7 <br />Application Fo' <br />PUB�IC WORkS PERMIT <br />Print or 7ype Only <br />e <br />Describe Froposed Work <br />Project Address (il known) <br />ailin9 Address <br />1 171;'I� <br />ailing Address <br />i : ��i� <br />� : a., <br />PUGIic Wo�Ms Pcrmi� • ���c �������� <br />ame. oani.. �gyL/�(l�c�z— <br />PUCIICWorksFeo � <br />TolalFca <br />less ApPI. FCo PpiC $ <br />Delar.caDoe $ �� <br />-�J <br />,���.'�"���1^',!7'II.S�7 ���-� `.���`� - `-1�- <br />City Zip Phone <br />Attach four (4) copies of ulans for prcposed work - Draw to scale and note lhe following as applicable: <br />• Property Lmes • Cen�erline of streel <br />• Outline end dimensions ol all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading clianges <br />• Existing and proposed utilities � Show measurvments <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs in advancr. • phone 259•881 5. <br />2. All work shall be performed in accordance wilh this nermil and current City of Everett Design and Construction <br />Standerds and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE YUMBER 1-800•424•5555. <br />/T /S T�E �UBC�C G�,e/GS' T,r�!'.��cTv�S ��Ec'amm.�.t/D�o�.% <br />T//�9T T•5�E dL��au��/c� .GQUi.E'E {��'.PmiS��oN F�'or.� Tis� <br />Ocu.t�i2 oF �d7� '�"/B To �E�,o��- i/F_/rf/ L�9.eG�F S�[�T - <br />T2u.u.t �9��1 .11E9.e TN.� N� cae.d�2 aF �v� �i7 �ir.o�z <br />jo dui �o�,vl� TN. � y�vsE _ <br />Approved <br />FINAL INSPI <br />Approved as <br />everett <br />e <br />r <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259•8P15 <br />� <br />9�8� <br />Date <br />Date <br />W <br />� <br />� <br />�J <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT Of� CONDITIONS <br />The undersigned owner/applicanl here6y agrees to hold and save harm� <br />less the City ot Everetl Irom any and �II claims for damages, costs. <br />expense \or cause lion that ma)� aiise because of installation <br />and ma�;0,nance f the im rovement or other righl•of-way use hereto <br />applied Mr�and rther agr es to remo�e same upon notice from the <br />Cily an lo �epl e puhlic p operly damaGed thPreby. <br />1�RK UT RI� ED BY THIS PERN.IT MUST BE STARTtD WITHIN <br />O D�TE PERMIT IS ISSUED AND THEFEAFTER IS TO <br />8E DILIGENTL - URSUED TO COM?LETION. THI� PERMIT MAY BE <br />CANCELLE BY THE CITY UFJN ANY STOPPP.GE O� WORK ON TNIy <br />PROJECT OVER 90 DAYS DiiR �POW. � <br />