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Date.� <br />Application For <br />PUBLIC: WORKS PERMIT <br />Print or Type Only <br />ty <br />Describe Proposed Work <br />Ci�y <br />uiq. <br />S 7-1$'l <br />Pupbc Wo�Ms Pcrmi� • _ ��� <br />oina o�o�� • <br />PaO�icWmisFce s <br />101R1 FCO <br />le5sA�01(npPTi�S ��� <br />Balancr Oue S <br />rS � � �/=Y33� <br />Z�p Phone <br />Zip Phone <br />Project Address lil knownl <br />78-'3- l,��A.�� �,�, <br />Attach lour (41 cc: ies ot plans for proposed work - Draw to scale and note Ihe lollowing as applicable: <br />f t treet <br />• P� �rty Lines <br />• Outline and dimensions ot all existing and <br />proposed structures on the lot <br />• Existing and prcoosed utilities <br />• Center ine o s <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All cells for inspection shell be mede 24 hre. in advance • phone 259-8810. <br />2. All work shall be peAormed in uccordance with this permit and current City af Everett Design and Construclion <br />Stendards and Specilications. <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />D,�,�.EwRy �SyPCL f�E C'oi!/S��_'UGTEv u/i7i//.�/ T//.� <br />a0� DRi��c�.Wy EFS�inE�/7. <br />!%.G' P.g.� c.��.4;y �...:...�... �.� <br />s � <br />- . :.����`'r... 9- //- � <br />Approv�onstru qn — Dale <br />PL f f •—� /�//'S� <br />FINAL INSFECTION ��e <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett, WA 98201 <br />Phone: 259�8810 <br />ACKNOWLEOGEMENT OF CONDITIONS <br />The undersigned owner/applicaN hereby agrees �o hold and save harm� <br />less the City ol Everelt trom any and all claims lor damages. costs. <br />expenses, or causes ot aclion Ihat may arise because of instaliation <br />and maintenance ol Ihe improvement or other righl-ol�way use hereto <br />applied lor and luriher agrees lo remove same upon notice Irom the <br />City and to repl2ce public property damaged �hereby. <br />� 7' % � �, ��— <br />, _ u �"y� <br />Signalwe ol Applicant Dal <br />80pDA STOF OATE PEFiM1T ISEISSUED AND THEREA TER IS TO <br />BE DILIGENTLY PURSUED TO COMPIETION. TH�S PERMIT MAY BE <br />CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUFATION. <br />