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r <br />i.: <br />Date 'r� , <br />ppplication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Pu01ic WorkO Permit • l '=! � <br />elaq Deo�. + -- <br />PUUIi< Wa�ks Fee S <br />To�al Fea <br />Leae F00� Fae PeiE S — <br />9ala�ce Due $ � �, C` � <br />,�� �,, � i� r.a s <br />Owner %{aiGng Address City Zip Phone <br />-� r�, Y(� �,. -�P�•.� �` <br />I�I�. �,,�;'��:1; \, .r I�� �'..� �'1�.r���->� I', _�• ��I�; �I- •1 <br />Applicant <br />City Zip Phone <br />Describe Proposetl Work _ �/vST/5%LG `S'C/fj��,�li�y�/li-Ta' /�v /�Q �. �-tJ . __ <br />�� �f �i�7X � �c9 .Q19i��. /F%-c _ � <br />Project Address (if known) <br />,3�.�� y�� <br />Attach four (4) copies ol plans for proposed work - Draw lo scale and note ihe following as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed slructures on the lot <br />• Exi,ling and proposetl utilities <br />PEflMIT CONC�ITIONS <br />• Centerline ol street <br />• Indicate North <br />• Show any proposed g�ading changes <br />• Show measurements <br />1. All calls lor inspeclion shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be pertormed in accordance with this permit and current City of Everelt Design and Consiruction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you d�.g. TOLL FqEE NUMBER 1-800•424-5555. <br />--1'c-��-tt�L ��.►'�� <br />�.r-� .P.1-�--�`{ , <br />Construction <br />Uale <br />FINAL INSPECTION Date <br />Approved as ConstructeA <br />everett PUB�IC WORKS DEPoIRTMENT <br />� 3200 Cedar Street <br />Everetl, WA 98201 <br />Pnone: 259�8815 <br />-f �- �C,��C�— �.,A�—�1--� �T <br />ACKNOWLEDGEM�N7' OF CONDITIONS <br />�:. <br />�a <br />� <br />� <br />� <br />a <br />The undersigned owner/applicant here6y agrees to hold and save harm- <br />less the Ciry oi E�erett irom any and all claims for damagcs costs. <br />expanses, or causes ol action ihat may arise because of installation <br />and maintenance of the improvement or other nghPobway use hereto <br />applied for and further agrees to remove same upon notice Irom the <br />City and to replace public pr�perty damaged thereby. <br />�,_ �,►���- �/��I�9 <br />Sig aWre ot Appli M T— �— <br />W�RK AUTH+JRI�ED (3Y THIS PERMIT MUST BE STARTED WITH!iJ <br />1B0 DAYS OF DATE PERMIT IS ISSU(iD AND THEAEf�FTEF 15 TO <br />BE DILIGENTLY PU'.SUED TO COMPLEiION. THIS PERMIT MAV 9E <br />CANCELLrD BY THE CIT� UPON ANY STOPF'AGE GF WORK ON THIS <br />PROJECT OVER 50 DA\'S DURATION. <br />