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p M <br />b <br />IO C <br />C N <br />� H �/1 <br />� � � <br />o�o <br />�C N M1l <br />N H <br />� H O <br />"'R <br />M , � <br />H <br />H <br />N y <br />h� <br />O N <br />�c�r <br />ro <br />H O N <br />� �..;�, <br />- <br />I +� s <br />Daie I�� �,�ir0 l e.,:� <br />Appliw�ion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />vu�Lc woeka Perm <br />�Itl9 DeO�- � ��� <br />Puolic Woexs Fce 5 <br />Toia� Fec <br />Less Appl Fec Paie S <br />BalanceDuc S . _. <br />Address <br />Zip Phone <br />Descri6e Proposed Work � �, ��� �, <br />Prolect Addr�ss Iil known� �� �� � A/�� I���,�la.._ <br />Attarh lour (4) copiea ol plans for proposed v.�ork � Draw lo sca'.e and note Ihe lollowiny as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Indicate North <br />proposed strucWres on the lot • Show any proposed gradin9 changes <br />• Existing and proposed �tilities • SF,ow measurements <br />'� nn ninT INnITF RFI f1W THIS 1 INF <br />PERMITCONDITION�� <br />1. All calls for inspection 5; 311 he made 24 hrs. i� advance- phone 259•8810. <br />2. All work shall be pedur^ �tl in accordance with this permit and current Ciry ol Everelt Design and Construction <br />Slandards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />�j� {�rz��. i-r �1D�" r�i��j . <br />�Gt,c.,�..�. �'In �lc�..L <br />�Z- �9-�`( <br />Approved Icr Construction Date <br />� FINAL INSPECTION Date <br />iApproved as Constructed <br />�'�i everrtt PUBLIC WORKS DEPARTMENT <br />I � �200 Cedar Slreet <br />I Everell. WA 98207 <br />Phone:259-8810 <br />� _._ __ .. . _ _ .._ . <br />' ____ _ _ ..... _ . _. -_ _ ._ . <br />Z <br />O� <br />ACKNOWLEOGEMENT OF CONDITiONS <br />The undersigned owner/applicant hereby agrees to holG and save harm- <br />less lhe Ciry ol Everett Irom any and all claims for damag�s, cosls, <br />ezpenses, or causes ol aclion ihat may arise 6ecause of installa��on <br />and maintenance of the improvement or other ri9h4ol�way use hereto <br />applied for and further a9rees to remove same upon notice Irom the <br />Cily and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHOFiIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERi�11T IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV B[ <br />CANCELLEO BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />