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Date�L�� <br />� <br />App!ication For <br />PUBLIC W�)RKS PERMIT <br />h� �5"�-; <br />1Vu�Fs Pgrmil • �= _ _.. <br />am� oec�.• <br />A¢ \YorFs Fce <br />lolel Fee S <br />Less An01 Fnc Paia > <br />!�� <br />Print or Type Only Qe�i.,���o�oo 0o s 3-�-= <br />r» vi vi <br />O "� M <br />O �i� ti� � 27�208Jr <br />Project Address (if known) <br />Attach four (4) copies of plans lor proposed work - Draw to scale antl note the following as apGlicahle: <br />• Properly Lines <br />• Outline and dimensions of all existin9 and <br />proposed structures on Ihe lot <br />• Ezisting and aroposed utilities <br />• CeNerline of street <br />• Indicate Nurth <br />• Show any proposed grading changes <br />• Show measurements <br />PER�dIT CONDITION:i <br />1. All calls for inspectiun shall be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be pertormed in accordance with ihis permit and currert Ciry of Everett Dtuign and ConstrucEon <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />' ' -- ��— � ,�.-lriv::t,<i��G= <br />, GC-D�c� �.� F3',= v�� :v;= , c.c f�c,�TE��'i IT <br />�C:4�/ �if',Di'CaT<] Bf//�r�'r�uC L[.�:>tK:�� C.1/ G'-/✓-h'% <br />�,Y.-it-��'�c, _ f3-/� � <br />Approved Jor Construclion Date <br />/ i«iL�/( r�- �� 3�, 7 <br />F�IiJ� SPECTION' � ate <br />Approved as Constr�cted <br />everelt PUBUC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl, WA 9R20t <br />Phone:259�881J <br />ACKNUWLGDGEMENT OF CONDITIONS <br />� <br />� <br />� <br />The unde�signed owner/apUlicant h�reby agrees to hold and save harm- <br />less ihe Gity of Everetl from any and all claims for damages, costs. <br />expenses, or causes of action that may arise because of installation <br />and maintenance of Ihe improvement or other right-ohway use hereto <br />applied lor and luriher agrees to remove same upon notice irom ihe <br />City and to replace public property damaged Ihereby. <br />�(J �1 � � � S-lS-B� <br />Signature� of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST aE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED ANU THEREP�FTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT Iv1AY 8E <br />CANCELLED BY THE CITY UPON l�NY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS CIURATION. <br />