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Date�1�-��7 <br />/ Application Fo: <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�.S'9�€. <br />Applicant <br />'� 7- G.C'y�c•o .9�f' Ec <br />Mailing Address Gi <br />Mailing Address <br />n,��,�,<<vo,.� ve,�n�� a _ - <br />- /D.^ <br />oiaa. oea�. , <br />Pu�IIc Wa�ks Fee <br />Totel Fec S <br />Less Fppl Fee Pa�a 5 �j <br />eaianco ove S ! � �� <br />a <br />7_ip Phonc <br />Describe Proposed Work _ COi!/ST�@ULT F.�.�/CE Lil/T/�/it/ Tfi'E C/TS� <br />.P6�r a�- ��y -- <br />FroJect Address (il known) <br />Attach lour (4) copies ot plans for proposeu work - Draw to scale and note the lollowing as applicable: <br />• Pro�erty Lines <br />• Outline and dimensions of all ex sting and <br />proposed structures on the lot <br />• Existinp and proposed utilities <br />• Centedine of street <br />• Indicate North <br />• Show any proposed grading �hanges <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. �n advance - phone 259-881 5. <br />2. All work shall be performed in acrordance with this petmit and cu« ent Ciry of Eveiett Design and Construclion <br />Standards and Specificalions. <br />3. Cali Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />� �/D PFJ.�T vf' ih�E FcivCF S�9CC c9t' f��6.5��r2 T.si�� <br />�/2 � Ctl./T��t/ T�� �G/!T C�,�'-- C�Jf,'�/ � is/i�r �rJoU��d <br />/ <br />INCCctt7E' i�/E {�NG� �i2oA/Ti�/G /�CONC- Gn'A�/1� <br />ff ��LSo G��� �(-'v,t/ .tifiC.(' D.tl S.p� �///�2 0 S, <br />��v� <br />k <br />� <br />'ji1i5 SfCT.c�/� x <br />vz''„�ak � <br />x <br />� �/2��It7AK A[0/�/�' , <br />T �c -- x --x-'�c—x'n <br />x <br />I <br />j � Tflir SFcTo�/ <br />c �Z�' MAx <br />y �` ' � _ � � /: :! -,'/ <br />'���—_ -r-' <br />ApproyEd for Construct' i � �bate <br />/ ,1�'" <br />'(_1 <br />' G�' 2 - /- �f <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMGNT <br />� 3200 Cedar Street <br />Everett, WA 98Y01 <br />Phone:259��815 <br />.S f�.r,t,E To , l3E ,f'Eint�vE.O <br />yT ot�N��S FK.+�E.�/� � �{ <br />JN i�� ��v,e.�- Tn'E LiT� <br />NE�vS To �/Ti,!�ZE Ty�S <br />,PiGr�r-o.� U/qy <br />ACKNOWLEDGEM[NT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less lhe City of Everel� irom any and all claims for damages, costs, <br />expenses. or causes of action lhat may arise because of installation <br />and maintenance of the improvement or other righPohway usc hereto <br />applied lor and lur�her agre� to remove sa e upon notice Irom the <br />City and to replace public propC7ly damage ereby. <br />�;� i�� <br />x �� � �i�,.' � �.,, " r�1-dfi�-' <br />Sign tu/e6tApplican) . . � Date <br />WORK AUTHORIZED BY THIS PERMI ST BE STARTED WITfiIN <br />180 DAYS OF DATE PERMIT IS ISSUED AN 1 THEREAfTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERM1IIT MAY QF: <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />