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Date��� <br />^ Application For C <br />� PUBLIC WORKS PERM�T <br />Ci <br />f"1 <br />Print or Type Only �. <br />AN� V ri <br />KL�J �� Q�.f�O� SO(� E. I�i� R�� � <br />Cwne� A4a�hn�:; 4r.dress _, <br />� d-jC,aoM Q�'�►n <br /><;� <br />f.l� 1 <br />� <br />� j ru <br />_�c.�i� <br />. <br />z�n <br />�� 'r.i <br />� i�i <br />p . i.. <br />r��_� <br />/ <br />Puohc WorMa Perm�i • • � <br />emg. o�o�. • — <br />PunhcWo�Msfee s <br />Tolnl Fee <br />Leia 4D0� Fer Pa�if S�- <br />Bd�T�CP D�C s �"O � <br />B T% <br />r,j <br />Applicant PAadim; Address ' Zip Phone <br />S-F+�'t .R 11� y �' <br />w. 1 i n w� �• ''OK SOO O� i...�/C �J <br />Describe Proposed Work �_PY �--2---L--- j- �— - �;--� �s— <br />F�� e�.. .., b�n,,.�_ ;1 �--�—�Q—j� ��-�'�-- <br />�e�j,� p�I C <br />Project Addre.:s f�f known! _�Y(y �� �+.*.� v i7_�V�Pi -sr_1L��______.— <br />$O/ <br />Attaeh four (41 coPies of Plans ta ProP�sed wo:�. � Drav: t� ,r,�i., .�n,� noie ihe'oilu:�+iny as anUhr.abl,�. <br />• ProPer�y Lines • Cen�eilinn nf sireet <br />• Outline and dimensions ol all exishnq and • inhicale Nnrih <br />proposed sVuctures on Ihe loi • Show any r.roposed yratlm� r.hanges <br />� Ezis!ing and proposed utilitles • Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls tor inspection sF+all be made 24 hrs. in advance • phone 259•861 O. <br />2. All work shell be peAormed in acco�dance with this permit and current City of Everett Design and Construction <br />Stenderds and Specifications. <br />3. Call Locatlon Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800�424•5555. <br />4� M�►J�►►►►� R zs ►�r ��� �2bM €..�x� oF 5��rn <br />CN+�1N�t_ . <br />S /�jggP ��/ Sf'ree�"s cLe4n a� oCC tirnes <br />(o. Pite-rX.d� � _r�-o�-� ca�+.f a� � c��.�c..t�.� � .�iai <br />��� � �� <br />_-_- �2�� ��� B%a � _�'s _ <br />Approved tor onstruction Cale <br />FINAL INSPECTION Date <br />Approved as Constructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259•8810 <br />� <br />AGKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />H <br />� <br />O <br />a <br />T ho unAerciqnetl owner; apphcant hereUy agrnqs to hOld and save harm� <br />le;s Ihn Cily ot Everelt Irom any and all claims for damages. costs. <br />cwpenses. or causes ol action ihat may anse beceuqe of inslallation <br />anA mamlenance o! ihe imprOvement or other righ�-of-Way uSe hefe�o <br />apphe,: lor and further agrer,s lo remove same apon notice I�om Ihe <br />C�!v and tn reolace qubhc properry damaged fhereby. <br />'VM, � � <br />S�a��ature ol Applican! Oate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE S?ARTED WITHIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE D�LIGENTLY PURSUEO TO LOMPLETION. THIS PERMIT MAY BE <br />GANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVEf; 90 DAVS DUFATION. <br />