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Ga!e � 9 <br />App;ication For <br />PlJL�LIC �1/�R�CS l�E�iIIAIT <br />Print or Type Only <br />, � <br />Owner <br />��� <br />Address <br />Applicant Mailing Address City Zip <br />Describe Proposed �M1'ork <br />Pu�lic Wo:ks Permit x <br />eie�. oeo�� + ��'F� <br />/ <br />Fu�IlcWarkSFro S <br />ToL�I Fee — <br />Lesa AppL Feo Paid �J _ <br />BaWnco Oue <br />ProjectAddress�ifknovm) �� SF_- r,,�e�o7;`/�i/G(�la��— .s�1C:f� z <br />/ "�— <br />Altach four (4) copies ot plans for proposed wo�k - Draw to scale and no;a the folle��iny as applicable: <br />• Proaerty Lines <br />O Outline and dimensions of all exis'.ing and <br />proposed siructures on the !ot <br />e Existing and propose? utilities <br />Approvedtor <br />PERMIT CONDITIONS <br />! Centerline of slreet <br />• Indic�te Norih <br />i Show any proposed grading changr,s <br />• Show r�ieasu-ements <br />s� ) aa�-s <br />Phone <br />7. All calls for inspec�ion shall 6e made .4 hrs. in advanr,e - phone 259•881 5. <br />2. P�I work shall ba perfoimed in accordance with this permit and current City of Everelt Desic�n and Construction <br />Standards and Specificalions. <br />3. C211 Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />,; !!C� �/J�G /G GU'D.�-� Pl-"•�/�liT /j�c�"�Uii2l'�O <br />�� <br />`T '2 � o ,9 ��S <br />FiNAL INSPECTION <br />ApFroved as Conslrw:ted <br />everett PUBLIC WORKS DEPARTMEN'! <br />� 3200 CedarStreet <br />Everetl, WA 98207 <br />Phone: 259•88 7 5 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />, <br />�I <br />0 <br />♦�� <br />VJ <br />C� <br />� <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less ihe City of Everelt Irom any and a9 claims tor damaqes, cosls, <br />expense ;, or causes ol aclion thal may arise because of installation <br />and mainlenance of the improvement or mher ric�hbohway u;e here�o <br />applied for and turther agrees to remove same upon notice Irom the <br />Date City and to replace Uubli� property damaged Ihereby. <br />Date <br />Signalure ol Applicant �ate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERM1IIT IS ISSUED i�ND THEREAFTEa IS TO <br />BE DILIGENTLV PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BYTHE CITY UPON ANY STOPPAGE OF WORK iJN THIS <br />PrIOJECT OVER 90 DAY;i DURATION. <br />�1 <br />Z <br />0 <br />� <br />c'� <br />m <br />�. .. <br />—i �1 <br />.-i � <br />N 2 <br />m <br />0 <br />co <br />mo <br />� <br />—i c <br />0 3 <br />m <br />s� <br />m <br />A Z <br />C <br />D —I <br />rx <br />-i N <br />� <br />� <br />� a <br />3 <br />—� m <br />m� <br />0 <br />� <br />or <br />c� m <br />c �n <br />f3+'1 N <br />z c� <br />--� r <br />• m <br />a <br />� <br />� <br />_ <br />a <br />z <br />--� <br />� <br />� <br />Z <br />0 <br />-� <br />n <br />m <br />