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o�,e����'��(� <br />Application For <br />PUBLIC Vt�j�')�3KS� PERMIT <br />Print or Type Only <br />Owner <br />Applican� <br />f`�T� �IQZH <��/�i��, <br />Mailing Atldn:ss <br />Ciry <br />��� <br />ZiF: <br />B� - �'�i <br />Puo��.c Worhs Perma ��j/� <br />BIC9. Dn::�. s iJ "i� !�_ <br />Popi�r, Works Fee <br />Total Fee 5 <br />lercSAVPlF0ePn14 S �`,�__ <br />8ao-nce��vo $ ___.__ <br />ne <br />Phone <br />Describe Proposed lYork 'v � w I C� �l ��i�-i I U r-1 ,,�l r L� �u p Y , � Q 0� ��.� j 1 L�%C.� <br />�Ll.ri (�+ �i�L 1 C T12� C/iL. -1— �G.-v�.. (ii N�v l,-P l� C U/� P <br />Proler.� Acdress (if bnowN __ -�— � �� .�C ���I� •% �i /UT — �,�, 7/I�/ i���/%4 <br />—� <br />AtWch lour I�I copies o� plans for proposed work - Draw to scale and note the lollowinq as applicatle: <br />• Property i:nes <br />o putiine �nd dimensions of all existir�g and <br />proposer siructures nn Ihe lot <br />• Existing and Groposed ulili�ies <br />PERMIT COPJDITIONS <br />• Centerline af streel <br />• Indicate North <br />• Show any proposed grading changes <br />• Shcw meesurements <br />LINE <br />1, All calls for inspection shall be ma9e 24 hrs. in 3dvance � phone :La9•881 5. <br />2 All work shall be performed in accordance with Ihis permit an;J c�rcrent City of Everett Desi9n antl Consvuct on <br />Standards and Specilications. <br />3. Call Wcation Ur�derground Service 48 hrs. hefo�e you dig. TO'..L FREE NUMBER 1•800•424-5555. <br />�� , �LL Oiz�"���GS �S/d"'4"r��_ g� �-%'+c�VL£J� � <br />/�D n��PvShJ�C�j �;�1� ,�-bJ�ElcC-r-�7- �'ts, <br />S. c��r�c= �o�' Sa sa-� �...�DT- -po i n-� pia-e7— <br />�s�� �-cc�rr— wrs, <br />���m�_ �. 7���G <br />ApprOved �or Co Iruclion � Dafe <br />` �7� 7 — <br />FINAL INSPECTION Dale <br />�pproved as Consvucted <br />evcre�t FUBLIC WORKS DEPARTMENT <br />� 3200 C��dar Street <br />Everett, V!A 98201 <br />Phone:259�8815 <br />ACKNOWLEDGEMENT OF r,ONDITIONS <br />W <br />� <br />�w <br />_ / <br />The undersigned owner/appticant hereby agrees to hcld and save harm- <br />Icss the City ol Everett Irom any and all claims for damages, r.osts, <br />expenses, or causes of action that may ari,e because of installation <br />and maintenance ol the improvement or other right-of-way use he�eto <br />applicd lor and furlher agrees to remove same upon notice irom the <br />City and to replace pub ic properry damaged Ihereby. <br />�'�,�;I�- c� ..�-- —1 � z 1'; � <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT A1UST BE STARTED VVITHIN <br />100 DAYS OF DATE PERMIT IS ISSUED AND TH[REAFTER IS TJ <br />BE DILIGENTLY PURSUED TO CUMPLETION. THIS PEFMIT'd��� BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OP WORI< Crv �-�ii` <br />PROJECT OVER 90 DAYS OURATION. <br />