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�- <br />� <br />Da:e � � � 6 � <br />appticetion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mai�ing <br />AppliCant <br />Describe Proposad Work A�� <br />Project Address (if known) <br />s�, � <br />� <br />ity <br />PuollcWorksv t. �� /�'/ <br />eiaa. oeau _ <br />� `• 7i 3 <br />PUEIicWorksFee O �-� <br />Talal Fee S <br />�ess nou� Fae Pma <br />Balcnce Due <br />Attach four (4) copies of plans for proposed work • Draw lo scale and note the lollowing as applicable: <br />• Property Lines • Centerline ol slreel <br />• Outline and dimensions oF all existing and • Indicate Norih <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed uti�ities • Show mea:urements <br />PERMIT CONDITIONS <br />s <br />S �. o c� <br />�a �.39 <br />�P�3.rs"- /i S.3 <br />Phone <br />t. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Construclion <br />Standards and Specifications. <br />3, Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />/S�l� I,�SP_ ��-IC�Jy�`�'•C C'1nr�j c�G1�(PSS�o�. �n..�rSs oV'78.wiSC' <br />��`�.,..� �... d-�o -1�er� �y d-i�e i��.6�,� 1.-uo��.s <br />�—�``'Pctti/. / <br />V <br />`_ ; ���c�:� �-�y-�y <br />Approved for ConstrucUon � Da� <br />�--7 �/ �j <br />��--�i� G�i/ `—' �� /''.f% <br />fINAL INSPECTION Tale <br />Approved es Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar StreM <br />Evrre�t, WA 98201 <br />Phone:259�8815 <br />{.- <br />ACKNOWLEDGEMENT OF CONDITIONS <br />-� <br />W <br />�"' <br />� <br />� <br />� <br />� <br />a <br />The undersic�ned owner/applicanl hereby agrees lo hold and save harm� <br />less ihe City ot Everett trom any and all claims for dameges, wsts. <br />ezpenses, or causes of action Ihat may arise because ol insla�lalion <br />and mainlenance of Ihe improvement or other right�ot-way use hereto <br />applied lor and further agrees to remove same upon notice Irom Ihe <br />City and ro replace public properl amaged thereby. <br />Sig ture ol Applicant Dale <br />W�RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORI<ON THIS <br />PROJECT GVEfi 50 DAYS DURATION. <br />..� <br />rt <br />