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Date�� <br />Appltcation For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />f �o.��,.��d� <br />Address City <br />Address ���Y <br />' Sr-�e <br />Describe Proposed Wo�k U <br />Pu01it Wo�ks Parml� • � � � <br />eia9. oeo�_ • <br />Public Works Fee s ��Q �� G <br />Tolal Fee <br />Less AOP� Fea Paid S� <br />6alen<a Dua S �• V J <br />Project Address (if known) " ' ' ' - � <br />Atlach tour (4) copies of plans for proposed work - Draw to scaie and note the following as applicable: <br />• Property Lines <br />� Outline end dimensions of all existing and <br />proposed siructures on the lot <br />� Existing and proposed utilities <br />• Centerline of sireet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />��/ <br />��ay� �� _��� <br />PERMIT CONDITIONS <br />t. Ail calls tor inspection shall be made 24 hrs. in advance • phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standerds and Soecifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-500•424-5555. <br />�V�oo� —G�ra�..s w.�..,Y- 1oe ����lY-I�M'CU ��.,.. f'b S.cie—Se..,el <br />. <br />S. �`/flof � M.0.1�\v�` Cuirb C� Iw� �1.1C �t. <br />� J <br />i` - w,�.4 L� \ S � G'..r- � o� ..�� � O� an t t� �� <br />l� � ��7 <br />I //� `` ��Q YhLJ'l"t �O�G <br />\v� �-{nt �IG�C� W �r` ^ <br />'��r.^>�o C'�k�s�/ � ��Pirw.�.nt �(��Vv�J� <br />�.�.��� _ <br />"�iP�`�1 � - .2 ^.z/-� <br />� <br />'�pproved lor Construction Da e <br />��> / <br />�,� � � -� � - �y <br />�� Date <br />FINAt INSPECTION <br />Approved as Consiructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259•8815 <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/app�icanl heieby agrees to hoid and save liarm• <br />less the City of Everett irom any and all claims for damages, costs, <br />ezpenses, or causes of action that may arise because of installation <br />and maintenance ot the improvement or other right-of-way use hereto <br />applied for and turther agrees to remove same upon ootice (rom the <br />City �{d to fqplace Public9roperty d�ar ged thereby. ` � <br />icant <br />yy�CyAUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER �S TO <br />BE DILIGENTLY FURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />z <br />0 <br />-{ <br />� <br />m <br />��. <br />� <br />..� <br />N 2 <br />m <br />c v <br />m o <br />t-� <br />--� c <br />O m <br />i --=-I <br />m <br />A Z <br />c <br />n -+ <br />�� <br />-� v, <br />K <br />T <br />O A <br />T � <br />� m <br />x <br />m N <br />o r <br />c� m <br />c �n <br />3 N <br />m <br />� r <br />• m <br />n <br />� <br />--� <br />2 <br />a <br />z <br />� <br />� <br />� <br />Z <br />0 <br />� <br />� <br />m <br />