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� . ' � � .ii <br />Application For <br />✓ <br />Pu]lic Woiks Permit a �/ ✓ �� �/`-" <br />r ��p <br />BI�B. DepL � �S[1p�E� _ <br />PUBLIC WORlCS PERMIT P°°TaWF�aF°a �— <br />Less Poo�. Fec Paitl S�/� <br />Balance0uo $ ��1� <br />Prirt or Type Only <br />Lana��pp�iia t l 2.4D6 13��.,�C�(�P�� (?�r�..,�. Lvn.�/��nn� 4h'n2 �`{�; -�9G7 <br />ne� MaJing Address ity LP � Ph6ne <br />A <br />Applicant Mailing Address City ZiP Phone <br />� <br />• . . ♦ G 1 r. / � II ' . . • i i__ ♦ /�♦ _ I. •' <br />Prolect Address (if known) <br />Attach four (4) copies of plans lor proposed work - Draw to scale and note the following as applica6le: <br />• Pioperty Lines <br />• Outline and dimensions of all existing and <br />proposed siructures on the lot <br />• Existing and proposed utili�ics <br />• Centerline of siruet <br />• wdicate Norih <br />• Shuw any proposed �rading changes <br />• Show measurements <br />PERMITCONDITIONS <br />All calls for inspection shall be made 24 hra. in advance - phone 259•8810. <br />All work shall be performed in accordance with this permit and current Ciry of Everelt Desir�n and Construction <br />Standards and Specific2tions. <br />Call Location Underground Service 4� hrs. be(ore you dig. TOLL FREE NUMBER 1-500•424•5555. <br />�i ( G9v7a /�i-lu-7E- �'i.�c.v�-u�y .�i'+-Y'w.'�� lQC/�. � .f.�2sc�a.n.c�'�..�0 % <br />4 <br />2. ,t�n�o�r .��.�.d-_"„" �'�' � ���-�-� -`�..�`�'L .�Ct� <br />�/.r'�.C?` Gu.s,(. � ,�� ,S'-t`��/',�,,/� 3 .3 � �' 3�S <br />� ([pF cES HlTiyCa'Ep> <br />.�_ �/.S.e�G9•eo �ni oir�.n•rr s / � Z /.r /fovs� <br />� S�i���lJ.ti /��9�6'8 <br />Approved lor Con ructi Date <br />�G -� � /7 <br />FINHL INSPECTION Date <br />Approved as Consiructed <br />everett PUBUC WORKS DEPARTMENT <br />3200 Cedar Street <br />(� Everetl, WA 98201 <br />Phone�.e59-B810 <br />/-S Fti.� Fco,��'o <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />� <br />The undersigned owner/applicant hereby agrees to hoid and save herm- <br />less the Cily of Everett trom any and all claims for damages. costs, <br />expenses, or causes ot ac�ion ihat may arise be�ause of installation <br />and maintenance of Oie improvement or olher righl-ot-way use hereto <br />applied lor and further agrees to remove same upon notice from �he <br />City a�d lo replace public properry damaged y.� <br />WO AUTHO IZE BY THIS PERMIT MUST BE STAfiTED WITHIN <br />18 DAYS O D E PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGEN PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DUHATION. <br />