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!! 3S-o�Y-SY p / <br />Date� �y���--q�/���-p�I I Puf�lic Work3 Pe�mO �c s�L� �"S ._ <br />/ ' oiap Deot. �z ZZ-:Q-Z-�-- <br />ApFlication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing <br />Mailing Address <br />Describe Proposed Work <br />Cily Zip <br />City Zip <br />AP_ — /�_rv T , <br />Prolecl Address (il known� / / ='� - �vi [. iruc � i � . <br />Attach four (41 ccp�es ol plans lor proposed work - Draw lo scale and no�e �he following as apPlicable: <br />• Property Lines <br />• Outline and dimensions o1 all existing and <br />proposed siructures on �he lot <br />� Existing and proposed utilities <br />Puohc V�ar4s feo <br />To', �� Fec 5 -- <br />Le55Ap0��FeePaW g <br />�%p <br />Baianca Duo S � 0—� <br />• Centerline of sireet <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />Phone <br />PERMIT CONUITIONS <br />1. Ail calls for inspection shall be mede 24 hrs. in advance • uho�e 259-8810. <br />2. All work shell be performed in accordance with this permit and current City af Everett Design and Construction <br />Standartls and Specificalions. <br />3. Cell Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•$00-424•5555. <br />T, .��t'L —�1�[.a2�;,� 1J?l.t.�tGtl luAG- CC�� 2.-d/ �1t�.(�cc!/ <br />�„� � ��-f .e«�6 �..�C���,�a�f� � c�� �4`a���0�os¢3n�. <br />5. r�,�,a�'.j.CY� �v.�� �-�u�.� �a.� c.:.ty s-f�,.,.��� s=c-�7�"m.✓ �.�7 <br />�,,..� �z sza�� 3�/7. <br />I'` <br />�P/6S OF !'Ti�i7� CH��TS A�t"^�NcOJ <br />.zl��� �-ai s <br />Approved Iar Constructi � Date <br />, G `�/ /� -30 -Io <br />FINAL INSPECTION Dale <br />Approvr� as Consiructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200CedarSireet <br />Everelt. WA 99201 <br />Phone:259•8610 <br />ACKNC`.NLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />The undersigned owner/applicanl hereby a9rees to hold and save harm• <br />less the City of Everet! irom any and all claims for damages, costs, <br />expenses. or causes r,f action that may arise because ot installat?on <br />and maintenance ol 1ne imUrovemenl or o�her right-ol-way use hereto <br />applied for and lurther ag�ees lo remove same upon nolice from the <br />Gity and to replace pu6lic property damaged Ihereby. <br />ORK �UTHORI2ED BY THIS PERMIT MUST BE 6TARTED WITHIN <br />80 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />