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Da±e�� ,-�� <br />Application For <br />PUBLIC WQRKS P�RIlAIT <br />Print or Type Only <br />mawng r+adress <br />ary <br />4��m.o P:o�rs Pmmn <br />9'2/8 <br />Bldg Dept � �� � � <br />Puooc Worxs Fee <br />Total Fee S -- <br />Less AopL Fcc Paia $ <br />7 � <br />palnncn puc $ -' �� — <br />Phone <br />City Zip Phon? <br />Describe Proposed Work _�� rC��i� �c _1 �����/,�� <br />Prolect Address (if knowa) <br />Atlach four (4) copies of plans for proposetl work - Draw to scale and note the tollowing as applicable: <br />• Prop� �ty Lines <br />• Outline and dimensions of all existing and <br />propo.:ed struc�ures on the lot <br />• Existing and proposed utilities <br />• Centedine ol street <br />• Indicate Norih <br />• Show any p�oposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calis lor inspeclicn shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permlt and current City of Everet� Design and Cons�ruction <br />Standards and Specifications. <br />3. Call Locaiion Underground Service 48 lirs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />y,'' yD i'A,�;ci.UC— f's I,�r�ic�,-�o v,� S;.-� �'�,;,� oFF <br />�j/��j /�j //�. H/iL G .G�E !i'C LO:d E !� . v.�< /c � -c /Rf/ ri ivJ <br />f��,c>,r.z.� s.s%�rc .�� oFF' /li�F� �.�/�y:. <br />�/' /�Ai/•dG SilfJGG ar' %i:�i.vi/r!V/�'! �•'p� �°$/7/.:?[T OI�C�r <br />J� �� o f C.PuSifF1J .f'OCK, <br />G, IF �Qh'�^.�v.�'.-E,� /i'u��-off' F'oi� Nr�J /,-�SPrs�.?LT <�r/,ct /�;��r,'�� � <br />6"C�/2/10dNDi�J� f��E�'TiE'S 7yr� .9i�r'LiCFiNT /S Tn <br />%.t/STALL' �l CA7C/Y-,�,PJ:�/ �/� ���''�i�✓(r %s'.E'Eri', <br />% S.oE SE=t�;.�.� Tv Tifis %�'���E.c iS TO dE A�'� Dia/n�re,_ c.ti•t. <br />,5l/�pCi'L'Cn,�i I-r/iL[ dE .PEs�cy✓oacE F�'�� V`�qFKNOWLEDGEMEN OF ONDIT ON�E, <br />` f-.�/�r-,s�- �� �7 <br />Approved lor Constr - Dale <br />io - r-e-� <br />FINAL INSPE TION Date <br />Approved as Constructed <br />everelt PUBLIC WORKS DEPAATMENT <br />� 3200 Cedar Street <br />EveretL WA 96201 <br />Phone:259�8815 <br />W <br />� <br />_ / <br />� <br />� <br />yrA <br />V♦ <br />O <br />a <br />The undersi�ned owner/applic,ant hereby agrees to hold and save harm- <br />less �he City ot Everett Irom any and all claims lor tlamages, costs. <br />expenses, or �auses ol ac�ion ihat may arise because of instailalion <br />and maintenance ol the improvr.ment or other right-oFway use neretu <br />applied for and further agrees to remove Sane upon not�ce from ihe <br />Cily and t�lace public property damaged thereby. <br />(- �" �-c�---� <br />Si� alure ol Applican� Date <br />WORK AUTHOF'.12ED BY THIS PERMIT MUST BE S7ARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE UILIGENTLY PURS�'EO TO COMP�ETION. THIS PERP.IIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WOHK ON TNIS <br />PROJECT OVER 90 DAYS JURATION. <br />