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Datei�_9<'- <br />( � <br />Applicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�I�,SS Q <br />Applicanl <br />TO PnStiNG <br />�"' . 15 �3 � GOUn7�V GL✓� � <br />� Mailing Address f 3 <br />L�e . "/D 5� /�/4f fti Ave 17 <br />Mailing Address <br />n <br />iZ �fi-�2 <br />m;l <br />Pu�hcWo�MnPermit• /� �7 / � <br />eiea oeo�� • <br />com�� wo��s re� — <br />roiei Fee S <br />Lesf Foo� Fae va�a S <br />eria�« o�a _ s �0= <br />Phone <br />Phone <br />Describe Proposed Work <br />Pioject Address (if known) <br />Altach four (4) copies of plans for proposed werk - Draw to scale and note the following as applicable: <br />• P�operry Lines • Cemerline ol stieet <br />• Outline and dimensions o: all existing and • Indicate North <br />proposed structures on the lot • Show any proposed gradinc� changes <br />• Existing and proposed utilllies • Show measuremeMs <br />PERMIT COND�TIONS <br />1. AH calls lor inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be parformed in accordance with ihis permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FflEE NUMBER 1•800•424-$555. <br />� ��' �.t� �� � „ c� Q.f. <br />S C-G�'�.E:� <br />�. �e�� GcL`� <br />J r t"'.��r2_ C'l <br />a.�c.,CQ.rv L�� <br />�t�u/ �� 5r'� f- O� L✓ rc-� <br />�I ✓ <br />/ <br />i C-���'f �Q� � <br />C /`_ U <br />J'��C�� �L4,�1 � /'/ 4 <br />2e-C �i..C•hllU/ <br />,.£�i�. S.C�..h-�. �.lr� .2i. �c� 5�.�..�.�t� <br />,_-;,�/./��.,r,.� �[��3,y � <br />ApprovedforC�n�uc�ion � Da�e <br />� / <br />��. it. /--.1.�- -. -'� / 7 p_ <br />FINAL INSPECTION Date <br />Approved as Consiructed <br />�;j -� PUBIIC WORKS DEPARTMENT <br />�3200CedarStreet <br />[veretl, WA 98201 <br />Phone:259�8810 <br />60� �,n 2 �: G:v y <br />ACKNOWLEDGEMENT O(- CONDITIONS <br />W <br />H <br />� <br />Z' <br />O <br />� <br />� <br />O <br />a <br />The undersiyned owner/applican� hereby agrees to hold and save harm� <br />less the Cdy ol Everett lrom any and all claims lor damages, costs. <br />expenses. or causes ol a[tion that may arise because ol installation <br />and mamtenance of Ihe improvement or o�her right-ol�way use hereto <br />applied lor and further agrees to remove same upon no�ice Irom ihe <br />City and lo replace public property damaged thereby. <br />Signature ot Applicanl Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITfiIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND TNEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERAIIT MAV BE <br />CANCEL�ED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUfiATION. <br />