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SG-:°l! � � - /C, .i <br />Date /•�-St�` <br />Application For <br />PUBLIC WORKS PERlVIIT <br />Print or Type Only <br />FuoLc Worxs Permi� s ��� <br />Binq. Deo��' —� - <br />Pu�L< Works Feo $ <br />Tolal Fee <br />Less Appl Fee Paia S��.Ji')!/'�— <br />eziaoceouc S� <br />W-�� ����/��`� �C��1 �Jt�Z � �`��C. iL, �.�C�IU'� ��l��j c� ����% ! <br />Owne� • Maihng A•ldress Cily 2ip Phone <br />� Ap�;cant Maiiing Address Cdy Zip Phnne <br />Describe Proposad Work I IY�� � CL l� 17 I� �' Jl • <br />Projed Adtlress (if known) <br />Atlach tour (4) copies of plans lor Groposed vror!: � Draw tc sca!e and nole the lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed stmclwes on ihe lot <br />• Existing and proposed u�ilities <br />• Centerline ol sireet <br />• Indicate North <br />• 9how any proposed �radinc� Changes <br />• Show measuremen�s <br />DO NOT WRITE BELOW TNIS LINE <br />PERMIT GONDITIONS <br />1. All calis tor inspectiun shall be made 24 hrs. in advance - phone 259-$$10. <br />?. All work sliall be perfonned in accordance with this permil and current City of Everett Design and Conslruclion <br />Standards and Specifications. <br />3. Call Location Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />7, % Bf3C.c-Fcp« �i� /�,C',c'��,✓T�vn� r'�iLa%� �r�USi 6E <br />1�✓STi�cLEA aN TNE SiDF. � s�W��'- - <br />,S .9�/y rT�E'o.e�•�/ ae I,�NmqFiEO SiDEu/.OGk /��r�cr i�E .('EPL�nCE� <br />�i✓ Ti/E %��d%'oS�9GS f�on�T9Ur o�v i/uyT q�E, i0 Ty£ <br />SA, TiS%9CTi[�N Q� T/�E f�Ub'UG L�IOP_.C.f 1A�5/��<TO.L'. <br />Gi cS'� T E wo 2.0 %J ,5'6 �c�.✓,F �Ei� .9Pr'/'c ✓•�O <br />/�Gr9i✓ %>/�'TEO � -/-.5'u�' <br />;�! �i/ �'� / <br />A ved I— o cIL� / Date <br />� ��� �� <br />FINAL INSPECTION Date <br />Approe^-d as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cetlar Street <br />Everetl, WA 98201 <br />Phone:259-8810 <br />ACKNOWL[DG[MENT OF CONDI1lON5 <br />W <br />� <br />vw <br />_ / <br />Z <br />� <br />� <br />Y/ <br />� <br />a <br />The undersigned owner/appliCaN hereby ayrees to hald and savc harm� <br />less lhe City of Everetl irom any and all claims fo� damages. costs. <br />expenses. or causes o( actior that may arise because of installat�on <br />and maintenance ol the improvement or other right�ol�way use hereto <br />upplied for and iwther ag�ees to remove same upon notice Irom the <br />Cit and t� replace pu6hc roperry damaged thereby. <br />C ��,,��- <br />�a ure ot Appl ..ar Date <br />RK AUTHORIZEC BY THIS PERh11T MUST BE STARTEU WITHIN <br />190 DAYS OF DATE PERMIT IS ISSUED AIJD THFREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLE710N. TFIIS PERM17IT MAY EE <br />CANCELLED BY THE CIIY UPON ANY STOPPAGE OF WOflK ON T <br />PROJECT ObCR 90 DAYS DURATION. <br />