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Date��` <br />! <br />App�ication For <br />�Uai.►C WARKS PERMIT <br />Frint or Type Only <br />� <br />� <br />� <br />Addr..•�s <br />un <br />7 !� _ , <br />/zoL- /7-�� � <br />Pu�IICYlorkaPermi��p��� /�� <br />eiae. ora�.• a-U � �9� � <br />PubLc Wor13 Fee <br />To1ai Fee 5` -- <br />LessAoo� FeePa'�U S <br />�alance0ue .S_ ��— <br />Describe Proposed Work �ll-J-l�L� �' — <br />Project Address (if known) G �� �^OwC�' I� P/C� <br />Attach tour (4) copies ol plans lor proposed wor • Draw to scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline an� dimensions of all exis�ing and • Indicate Norih <br />proposed siructures on ihe lot • Show any proposed grading chanyes <br />• Existing and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259-8810. <br />2. All work stiall be performed in accordance with this perm�t and current City of Everett Design and Construction <br />Standards and SRecifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TULL FREE NUMBER 1-SGQ•424-5555. <br />T�S' l�Uj'��x /�7vs.— B� s�:o"9G.0 9/�Hx���u�� D/s�7'�.dc,E <br />�oi,o T,S��' tJ_FST �,�'o.�c2i� Li,v� i.tl o.�DEe �,e %N� QU�LEX <br />To Tis�� GT/�sT To C-�� ,�,r/ /l,vo oui oF Tisii! i�? �9.e.n�: <br />'����� / 8g <br />Approved tor Construc�i Date <br />���—� <br />FlMAL INSPECTiON Date <br />Approved as Constructed <br />evemtt PUBUCWORKSDEPARTMENT <br />� 3200CedarSireet <br />Everelt WA 98201 <br />Phone: 259�8810 <br />ACKNOV/LEDGEMENT OF CONDITIONS <br />� <br />� <br />♦ <br />� <br />O <br />r <br />N <br />O <br />a <br />Th� undersigned owner/applicant hereby agrees to Yold and save harm- <br />less the City of Everett from any and all claims lor damages, costs, <br />expenses, or causes of aclion that may arise because of installation <br />and maintenance ol ihe improvement or other rigM�of-way use hereto <br />applied for and further agrees to remove same upon notice Irom Ihe <br />Cily and to r ace Public proUerty damaged the�eby. <br />�`---;::����a\� ���— <br />SignaWre of Applicant Date <br />WORK AUTHORIZ[D BY THIS PERMI�� MUST BE STARTED WITHIN <br />180 DAYS OF DATE PEFMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY 6E <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OV[R 90 DAYS DURl.TION. <br />