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. _ _ _... <br />:..,.n.� ,..._,.— ___ � <br />Date y/� s /�G <br />/_ _ <br />Application For <br />P�IBLIC Wl7RKS PERMIT <br />Print or Type Only <br />r�namng nddress <br />Describe Proposed Work <br />�v, _ <br />� �.._.------ - _ <br />�. <br />Zip <br />Pu�lic Worke Perm[i^t �s <br />BIOB.Oept.r Q��/���ii <br />Poouc woiks fm <br />To�el Fee w� <br />�¢55 ApO� Feo Paid S <br />Balanco Oue $ <br />cip F+none <br />Project Address (if known) �D �.S� ,� I/`P�t��/,/ //lG�� �� �]i S��l <br />Attach four (4) copies of plans for proposed work • Draw to scale and notr. the following as applicable: <br />• Froperty Lines • Cr,nterline of s[reet <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�881 5. <br />2. All work shall be pertormed in acwrdance wilh Ihis permit and curr?n� Ciry of Everett Design and Construction <br />Standarils and Specifications. <br />3. Call Location Underground Service AB hrs. before you dig. T6LL FREE NUMBER 1•800•424•5555. <br />��/BL/G GUOP.,CS /�p/n/ % /�b �E6JU/2E.D <br />� D <br />y/�/a.� <br />; l <br />x�`'�' <br />Approved lur Construction Date <br />FINAL INSPECTION <br />Approved as Gonstructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everelt WA 98201 <br />Phone: 259-88� 5 <br />Date <br />J <br />W <br />` <br />r / <br />Z <br />O <br />� <br />� <br />� <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and savc harm- <br />less the City of Everelt from any and all claims for danages, costs. <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or olher righFobway use hereto <br />applied tor and further agrees to remove same upon notice Irom the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WI?HIN <br />18f1 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COti1PLETION. 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 />z <br />0 <br />-� <br />.. <br />c� <br />m <br />ti r. <br />� � <br />.. —i <br />N 2 <br />0 <br />m <br />co <br />m o <br />c� <br />om <br />_ —�i <br />m <br />r� z <br />c <br />�_ <br />� N <br />< <br />'�l <br />� D <br />3 <br />�m <br />m �-+ <br />N <br />or <br />c� m <br />c �n <br />3 � <br />m <br />Z� <br />�m <br />a <br />a <br />� <br />_ <br />a <br />z <br />� <br />� <br />� <br />Z <br />0 <br />� <br />� <br />m <br />