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Date 1:1 �� "s- <br />ppplicalion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />' ;,c. ^� ;[�_ <br />� /'��--- <br />Owner <br />�,� I'�/ �n�4ifJ/:i[' <br />Applicant <br />pescribe Proposed Work _ <br />C' <br />Project Address (if known) <br />� ���!_ r��ac �' ,I� <br />dailin9 Add <br />l /'vaJC <br />`�� c-/J /EJ//tl,�^ / <br />�, _ � <br />— <br />� <br />�/ �rJ�=s's� <br />Attach tour (4) copies of plans r proposed work - Draw to scale and nol <br />• ProPery� Lines <br />• Outline and dimension ��� <br />proposed structures on the lot <br />• Exisling and proposed u�ilities <br />�� <br />� <br />�,�.s =.SX % <br />Pub��c WorAs °aml + <br />Blep oeo�. * <br />�� � <br />Pub��c Works Fee 5 � �j� <br />Tolel �ee <br />LessADO� Fee P�'� S � 7G� <br />Balanco0ue S =�� <br />� Q �s�`5' <br />il::'�• --`S -�` �" <br />� <br />the lollowing as applicaUle�. <br />• Cenlerline ol sVee! <br />• Indicate North <br />• Show 2ny proposed grading chanyes <br />• Show measuremenis <br />� <br />PERMIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs. in advance - Phone 259•881 5. <br />2. All work chall be pertormed in accordance with this permit and current Gily ol Everett Design and Construction <br />Standards and Specilicatiuns. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•55 . <br />i� � =�' <br />�. <br />_.1�i � <br />si�:�_ c��=i�l� ��� i <br />a.,.� -�� <br />F1yft[INSPECTIUrv <br />qpproved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everelt, WA 98201 <br />Phone:259-8815 <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner,�apPlicant hereby agrees to hold and save harm� <br />less the City ot Everetl Irom any and all claims lor damages, costs, <br />�xpenses, or causes ol aclion Ihat may arise because ot installation <br />and main�enance ol the improvement or oiher right-ol-way use hereto <br />Citylland to eplace`publ 9Peopertyrtlamaged therebyn noticc from Ihe <br />._-�. �.� /.,// ��`j- <br />. �..- _-- <br />Datc <br />Signature ot Applicant <br />1Jd RDAYSTOFRDAT�E PERM1IT SESSUED AND THERE�FTER IS'TO <br />BE DIIIGENTIY PURSUED TO COMPI[TION. THIS PERMIT MAY BE <br />CANCELLED OV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJGCT OVER 90 DAYS DURATION. <br />