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Date �7��� <br />Application For <br />PUBLIC WC)F�KS PERMIT <br />j Print or Type Only <br />�- � <br />�� � <br />j Owner <br />Address <br />PUCIit Worke Permll • � � /.`/ � ' <br />� <br />eiao. oea�. r . , i � `� � . <br />PuClic Wo�ks Feo S ��� �� �� �J ' <br />TOtel Foe <br />lesa Aool. Fae Paid S I <br />6alanco Due S �� � V' � U � <br />�9 P6 , <br />� ;, , � -,�. `� _:->,�:' � <br />tity Zip Phone � <br />. i, - � �a;, � �i', ` <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work � � "` � � �"1 �^' � - .° - <br />�, <br />� �' l . - :.. - <br />??' <br />_ , <br />Project AdAress (it known) - � �� ' �� ' ` ` � � <br />Attach four (4� copies ol plans for proposed work - Draw to scale and note the following as apAlicable: <br />• Property Lires � Centerline ot street <br />• Oulline and dimensions ot all existing and • Indicate North <br />propoced structures on the lot • Show any proposed grading changes <br />• Existing and proposed uti��ties • Show measurements <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in acr.ordance with this permit and current City of Everett Design and Construclion <br />Standards and Specifications. <br />3. Call Location Underground Sen�ice 48 hrs. belore you dig. TOLL FREE NUMBER 1•800-424-5555. <br />%/ C �_ : v <br />y ;�.i�' ( / � . � _ - <br />� ' <br />Approved lor Consvuction Date <br />/c�- 9- �5� <br />FINAL INSPECTION Dat <br />Approved as Construded <br />everett PUBUC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Fhone: 259-8815 <br />1 <br />AGKNOWLEDGEMENT OF CONDITIONS �. <br />The undersigned owner/apDlicant hereby agrees to hold and save harm- <br />less the Ci�y of Everett irom any and all claims lor damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right�of-way use hereto <br />applied lor and lurther agrees to remove same upon notice from the <br />City and to replac�� public �roperty d�maged thereby. <br />� c <br />Signature of Applicant'� Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND ?HEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANGELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 50 DAYS DURATION. <br />z <br />0 <br />--i <br />n <br />m <br />h-1 <br />� � <br />Iti '� <br />� _ <br />v <br />m <br />c o <br />m a <br />--i c <br />�m <br />i -zi <br />m <br />.� z <br />n -+ <br />rx <br />., .� <br />� � <br />< <br />�n <br />o� <br />T D <br />='m <br />m� <br />� <br />o r <br />� m <br />C N <br />� N <br />nl <br />Z l7 <br />-i r <br />. m <br />n <br />z <br />-i <br />x <br />n <br />z <br />-i <br />� <br />� <br />z <br />0 <br />� <br />� <br />m <br />