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f � <br />Date! � _�� � <br />qpplicauon For <br />PUBLIC WORFCS F'EFiMIT <br />Print or Type Only <br />� <br />Describe Proposed LY��rc <br />ilmg <br />Ll u <br />Ma81ng Address <br />Pro�ect Adtlress (if known) '-` ���'"'-- <br />FUach four (4) copies ol plan� for proposed work � Draw to scale <br />• Property Lines <br />• Cutline and dimr.nsions ol all exie�ting and <br />proposed siructures on tl�e lot <br />• Ezisting and proposed utilities <br />Ci�y <br />Vub6cwcM1SPermilj•� �% <br />_� �� <br />Gi�g Dnp�. � _{,1.� <br />PueLc warks iec <br />,o,a� «� S — <br />Le55 Ap01 Fne PaiO S—� <br />Balanct Oue � —� <br />`L u � ...�i� <br />.. Phone <br />Lp <br />note the �ollowing as applicable: <br />• Genterline of sireet <br />• Indicate Norih <br />• Show any proposed gradi�g changes <br />• Show measurements <br />PERMIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be DeAormed in accordarce with this permit and current City of Everett Dasign and Construction <br />Slandards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you di�. TOLL FREE NU� a 1-Ft00•424•55 . <br />—��� (�GU` �'� l2� �� . <br />' ;,.0 ��1�1�� �. <br />li-��-�� <br />Date <br />qpproved for Conslruction <br />Da1e <br />FINP.L INSPEGTION <br />ACJroved as Ccnsvur.ted <br />everett F'UBLICWORKSDCPARTMFNT <br />� :5200 Cetlar Sireet <br />Everetl. ViA 99201 <br />Phone:259-8810 <br />� <br />O <br />qGKNOWLEDGEP9ENT OF CONDITIONS <br />The undersigned owner/applicant hereby a9re:es to hold and save harm� <br />less ihe City ol Everett Irom any antl all claims for damages. cosis. <br />exr.r.r.cc� �� �.;��°- r.f action !hat me.c znse because nl installation <br />and maintan, nce ot Ihe improve���enl or o:her righl-obwaY use here�o <br />applied for and luriher agrees t�� remove .;ame upon notice irom the <br />Cily anA �o replace puhlic properiy dama!a•�d Iherehy. <br />-.----- Dat�• <br />Signature ol ApP�icant <br />VJORK AUTHORIZED BY THIS PEriaAIT MUST BE STARTED b"JI�I��N <br />1g0 GAYS OF DATE P[RMIT IS ISSUED ANU THEREAFTER IS 10 <br />BE DILIGENTLY PURSUED TO COPdPLETION. THI: PE'RM:T MAV �E <br />CAWGELLED BY THE CITY UPON ANY S10PPP.GE OF �rVORK ON TI-1�5 <br />FROJECT OVER 90 DAYS DLIRA710N. <br />