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Date �> /�I /�'(( <br />/ ! <br />Applicalion For <br />Pll�LEC alVO1��ES PERMIT <br />Print or Type Only <br />City <br />Applicant <br />De�cribe Proposed Work <br />Proiect Address (if known) � 5a" <br />�] <br />Attach four (41 copies of plans for proposed work - Draw to scale and note the tollowing as applicable: <br />• Property Lines <br />• Ou:line and dimensions of all existing and <br />prOposed Struchires on the lot <br />• Existing and proposed ulilities <br />PepnC V/Orks P�nni1 a <br />oma. o�rn < J � _!�� — <br />Fablic Wnrks Fea a <br />TolalFee <br />less Appl. Fea Paid .S <br />6alance Oua � <br />! Centerline of street <br />• Indicate North <br />• Show any proposed grading chanyes <br />• Show measuremc:nts <br />� —� <br />Phone <br />Phone <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advanr.e - phonc 259•8815. <br />2. Ail work shall be performed in accordance with ihis permit and current City of Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Underground Servic� 48 hrs. before you dig. TOLL FflEE NUMBER 1•800•424-$555. <br />�� �,e� <br />/ L� `�L %C ir ��'/_./i.y" �(j�'✓ �� /- C�:�_j��i/'._-/--� � � � � UJ <br />/ � � i. c,l/ ' -S /"�. t' . � / if� <br />V.' <br />i <br />/ � <br />� J� /� ����/lf°✓//(/��/ �f/ ��'L ��_�,`� -2///i/_:,`- <br />% ;l/G/ (/ - <br />. . I��, �D �--� ��,G�Z�c!/�/�'c� . <br />ApprOved fur Cons�ruction <br />Dam <br />FINAL INSPECTION Date <br />Approved as Consiructed <br />r_vere[t PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 98201 <br />Phone:259�8&!5 <br />ACKNOWLEDGEMENT OF COND:TIONS <br />The undersigned owner/applicant hereby agrees In hold and save harm- <br />less the Ciry ol Everett from any and all claims tor damages. cosls, <br />expenses, or causes of action that may arise Uecause of inetaliation <br />and maintenance of ihe improvement or other right-ohway use hereto <br />applied for and furiher agre=s to remove same uFon notice Irom the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUSi BE SfAFTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AIJD THEREAFTEFI IS TO <br />BE DILIGF_NTLY PURSUED TO COMPLET�ON. THIS PERMIT ��1AY 6E <br />CANCELLED BY THE CITY UPON ANY STOPi°AGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />