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�. <br />TYPE OR PRIN'f ONLY <br />'�pllcation For <br />PUBLIC 1�.ORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />32C0 Cedar Street <br />Everett, WA 98201 259-8810 <br />Datc Z/21/9l <br />Public Works Permit # C7 �/�LU <br />Building Permit # 54'LF,9 <br />Public Warks Fee $ � � <br />P.=.11l liG;.')1:;�5 LI' 3oUi �J-. � �.V, :,C� - . <br />�i���'i"i <br />Owner Matling Address City 1 2ip phone <br />G.'�ViD BuliiiVtiTT Ot: �UtIP Sl�ll'i';, i'_'.—y�r:4 <br />Applicant Mailing Address City Zip phone <br />Describe Proposed Work �:LW t,u�;s� <br />r� <br />PROJECT ADDRESS (if known) <br />Attach four (4) copies of plans for proposed work - Draw to scale and note ihe following if applicable: <br />•Property Lines •Outline and dimensionc of all existing and proposed structuras on the lot •Existing and proposed utilities <br />•Centerline of street •Indicate North •Show any proposed grading changes •Show measurements <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone 259-8810. <br />2. All work shall be parformed in accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />Inshill au tnliltrrdic�r. tren!�li Luilt a�; par 5ri�hnn ;-)..G.? tmd [�irure aud'I';�bfe 3-!.7 ul Ihc ��h <br />itonnw�ker �i[mnqe.meni Nl�mual Icopy's stapied io dns pern�iij. 'Ii�e iidiltrrllion 4ench sf�.�ll 1,:� <br />ii0oci iLtu� 5 Is�el ii, �ICr tl�l �iu�7c'. 41CiiEit'I'i,% �lllB OP i0iLLl�i�il�ii 4bY C�OSCI' �IUIl IU f0l'-� �J IIlI� U�.��w:�, <br />pi aperty litrr m� tuun:l::tin:i. C'sll ?'uLlsc 1�4or!:s !or sm ins:p. c;ion pi i:�r to cos�eriqq h•-�uche>; <br />FINAL INSPECTION Date <br />Approved as Constructed <br />,� � ,. _�irqq,�.. . . <br />jS �V`� <br />� A �Ffy ' <br />"-i :40;:; J'.� <br />.. �'� ' �J_."!. <br />W <br />H <br />♦-^ <br />Vl <br />� <br />O <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned ownedapplicant hereby agrees to hold and save harmless <br />� ihe City of Everett from ony and all claims for damages, cos�s, expenses, or <br />causes of action that may arise because of inst211adon and maintenance of <br />the improvement or other right-o(-way use herelo applied for and further agrees <br />to remnve same upon notice from the City and to replace public property <br />damaged thereby. <br />Signature of Applicant Date <br />WORi( AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFfER IS TO BE DII.IGENTLY PURSUED TO <br />COMPLEfION. THIS PERMIT MAY BE CANCELLED BY'!HE CIN UPON ANY STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />