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Date c� � 6 <br />Applicalion For <br />PI�BLIC WQRKS PERMIT <br />, . . r .. . . .;n•;.. ._.—...a:w�c..nr�.:��..'-'*i'AG'?`^?��Y <br />Pubiic Wo�ks Pe�mil • / 1 <br />eiae oeo�.. '�F3 ��� I <br />pop��c �`b�ks Fae s <br />Total Fce <br />Less ApO� Fee VaW 5 <br />Baiance Oue 5 <br />Print or Type Only <br />;r � S % �G/i� <br />�!.//. ��'� A.O�(L�,! G�,/�� C /'I�' .J' !�( � � 1 � � i �- /� ? �.� 7r r'J _� %�5� <br />Owder �� MailingAddress ��-City Zip Phone <br />�; �-lLt.� <br />'�A Phone <br />qpplicant Mailing Address Citp ZiP <br />i;,, /.'�;l i': � ;. ,�� ;i.;�.r <br />Describe Proposed Work � i— �' �"---'j� � <br />^roject Address (il known) <br />Altach lour (4) copies of plans for proposed work � Draw to scale and note the following as applicable: <br />• Property Lines • Centerline ol streel <br />• Outline and dimensions of all eaisting and • Indicate North <br />propused slrucWres on the lol • Show any pwposed grading chanqes <br />• Cxisting and proposed utilities • Show measurements <br />PEFMIT CONDITIONS <br />1. All calis lor inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with ihis permit antl cur�enl City ol fverett Desi9n and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. belore you dig.70LL FREE NUMBER 1•8U0•424•5555. <br />/'!"'r�C /r'" l,! �_ i ; ,_ i>�- /.-rr/ /i/Ci/ . -.� "l�_ � ._ :'�. , <br />_i <br />. -. <br />Approved for Consiruction Da;e <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORY.S DEPARTMENT <br />� 3200 Cedar Streel <br />Everett, WA 98201 <br />Phone:2,59�8815 <br />/ ' <br />� <br />� <br />� <br />N <br />O <br />a <br />,4GMOWLEDG�MI`Ni bF CON^ITIONS <br />7he undeisnneA owner/apUlican� nriebY �9rees to hold ard save harm- <br />less the Gty ol Everell Irom any and all claims for damages, cosls, <br />expenses, or causes of action ihat may arise because ol installation <br />and maintenance of the improvemenf or other right-uf-may �ise here�o <br />applied tor and furiher agraes to remove same upan notice from the <br />City and to replace public p�operty damaged thereby. <br />Sign�lure o� AppGr,arl �'��� <br />WORK AUTHORIZED BY TFIIS PERMIT MUST BE STARTE� WITNIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEH IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />GANGELL[D BY THE CITY UPON ANY STOPPAGE OF WORK Olv THIS <br />PROJECT OVER 90 DAYS DURATION. _ <br />