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� <br />_� <br />Datel(_>� ��M <br />O� <br />PU�3LIC <br />O <br />� <br />O <br />Application For <br />WORKS PERMIT <br />o a0 0�_�0 <br />Print or Type Onl� `'' � ` � °- � " <br />.. ,' rn.-,..•oo� <br />;i rr.* u'�NK� <br />tli Ui v4 N <br />r <br />Pu01ic Works Pei r ��/� <br />BIaB. OeD�- � <br />J/ <br />Public Works Fea s <br />fotel Fea <br />Loss ApPL Feo Pald S <br />�alanto Oue S '2'�l <br />Applicant Mailing Address City Zip Phone <br />Describe Proposed Work ��% I(� <br />Prolect Address lif known) <br />Attach four (4) copies o1 plans for proposed work <br />• Property Lines <br />• Out�ine and dimensions ot all existing and <br />proposed structures on the lot <br />• Ezisting and proposed utililies <br />to scale and note Ihe lollowing as applicable: <br />• Centerline of streel <br />• Indicate North <br />• Show any proposed �rading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. A�I calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All �.vork shall be peAormed in accordance with this permit and current City oi Everett Design and Construction <br />Standards and Specificalions. <br />3. Cal� Location Underground Ser.ice 46 'irs. betore you dig. TOLL FREE NUMBER 1•800-424-5555. <br />-}, AS P�Z �v�5� Pr--ta�lJ �Y�Tf .�a�cc-�5 T� r4ci.ej' <br />f. S( DE .SE�?/�L sNAZ�. I'�E .��izA.t�-=l: 'Tc� T�.T 1.7� �.L , <br />��YH�EIZC— UhIDET�� � r�2A6i L, � � <br />I ,V � �/�/ <br />f� �j / <br />��� u� � � <br />,� � <br />��<� . <br />S�lvG� ��^ <br />� `' . �^ �l <br />U t ACKNOWLEDGEMENT OF CONDITIONS <br />- z-go <br />Dale <br />._%�j" � _l._�rD _ ,j..Y _ �� <br />\ <br />FINAL INSPECTION Date <br />rvcrett PUBLIC WOFKS DEPARTMENT <br />� 3200 Ceder Sireet <br />Everett, WA 98201 <br />Phone:259�8810 <br />W <br />F- <br />� <br />� <br />V <br />� <br />� <br />� <br />a <br />The undersigned owner/applicant herehy agrees to hold and save harm- <br />less the City ol Everelt Irom any and all claims lor damages. cests, <br />expenses, or causes oi action ihat may arise because ot installation <br />and R.aintenance of ihe improvement or other righboFway use hereto <br />applied lor and further agree!s to remove same upon nolice Irom Ihe <br />City and to replace public prop�rty damaged thereby. <br />Signalure ol Applicant Date <br />WORK AUTHORIZED 8Y THI:� PERMIT MUS! BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE OILIGENTLY PURSUED TO COMPLETION. THIS P[RMIT MAY B[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DUFIATION. <br />