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A <br />- -- -� — — - �-- - . : . ,- - -- ---- - -:- <br />d <br />-----�� , <br />� �' h � � a�oi�� wo�.. va�mn r � � � <br />D8�8 "' uiaa. o�oi. • — <br />qpplication For <br />PU�'3LIC WORKS PERMIT <br />O — _. ,+ <br />� x <br />Print or Type Onl�t, �-� � �: . <br />� � ; ,.; o =. �._ - <br />_. «. ..: � _+ , . <br />r:�J� ���'� � �� <br />T,� ,, � I:,n.s� �' T�. a/ � ��1*,' <br />ow�e� ... �:� � �, � � <br />� � ������- <br />_.,� z,;..�,..� <br />DeScribe Proposed Work <br />f <br />� � _- ,_, <br />��ing Adtlress <br />� � <br />�t � _'. <br />a. <br />f � : 4 <br />� .,�ti �— <br />a <br />PaOLCWoeksPoe s�;-.�(�� / <br />Tolrlfea <br />lasaROPlfeaPnA s!�— <br />�1d1TI1C8 �YB V � /�� �� <br />, <br />City uP ������� <br />Proiect Address (if known) '� � � � ' - � <br />Attach four �4) cop�es ol ptans lor proposed work � Draw to scale and note� CQo11e�line ot �peet� able�. <br />• Pioperty Lines • Indicate North <br />• Out�ine and dimensions ol all existing and � Show any proposed g�atlin9 ch ��•�es <br />proposed structures on the lot • Show measurements <br />• Exis�ing and proposed ulili�ie5 <br />PERMIT CONDITIONS <br />1. All calls tor inspeclion shell be made 24 hrs. in advance • phone 259•8810. <br />2. All work shell be peAormed in accordance with this permit and current Ciry ol Everett Deslgn and Consimction <br />Standards �nd Specilications. <br />3. Cali Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER i•b00-424-5555. <br />� � (�:� . � /��i� � _. . _'J � <br />'y. � :�>' <'`���`'7.� �./ �' - <br />„ <br />� �_' �- i <br />J,i / <br />t�' -"/,,' �� ,�"i <br />� Approved �or Construcli0n . �� Date <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />��r�PUBLIC WORKS DEPARTMENT <br />32U0 Cedar Slreet <br />Everett, WP 98201 <br />Phone:259-BB10 <br />�� .___._-__ <br />'�— <br />W <br />� <br />�w <br />_I <br />� <br />O <br />H <br />� <br />0 <br />a <br />ACKNOWLEDGEMENT OF CONDIilONS <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less Ihe City of Everett irom any and all claims for damages, cests. <br />ezpenses, or causes ol action that may arise because of installation <br />anJ maintenance of the improvement or other righFobway use hereto <br />applied lor and �uriher agrees lo remcve same upon notice Irom the <br />City and to replace public properly damaged Ihereby. <br />Signature ol ApPlicant � � �` , Da�e <br />180RD�YSTOFRDAT�E PFRMIT ISESSUED AND THERE FT�ER ISHTO <br />BE DIIIGENTLY PURSUi:D TO COMPLETION. Tf115 PEFMIT MAV BE <br />CANCELLED BV THE CIl i UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />