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Date I 3 J� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />PuGllc Worka Permil • u `j � <br />BiEp.Dept.+ $s/ / �/3os' <br />PublitWorFSFea S <br />Talal Fee <br />Lcu AOP� F¢e Pab 5 <br />BalantaDue S <br />`3•=2- yo •L�ro-//_.d3i <br />Describe Proposed Work <br />� IC11TIi 1—� 7�% �'AI�tIIJ( C�7� <br />Prolect Address (if kno�Nn) <br />Attach four (4� c�p�es ol plans for proposed work - Draw to scale and note � Ceo11e line ot stpeei able: <br />• Property Lines • Indicale North <br />• Outline and Aimensions o! ell enisting and � Show any proposed grading changes <br />proposed structures on the lot • Show measuremeNs <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />t. All calls tor inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be perlormed in accordance with this permil and current Ciry ol Evereu Design and Construdion <br />Standards and Specitications. <br />3. Call Location Underground Service 40 hrs. belore you dig. TOLL FREE NUMBER 1•800•424-5555. <br />ALGE�� S�pCv'u" Uy �LuT PL.d.t/ /S �/UT � <br />� / i <br />/�EDiCd7�l� /�U�LiG :a LLEy. Af�i`�L�G��T GLiCG <br />� S�ii3.sTAtiT/ATE l ��'� L <br />!�E .E EC� //i.eE D To � . �n %.yiS <br />ACCESS T�-� G4.NdbE .40niTin.�/ Fi cr <br />E•tJT.eQNC. E. . �E��criFo .e.v:c> n�' > <br />/-io-.�tF / <br />Approved <br />FINAL INSPEG��i)N <br />Approved as Consiructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 CeUar Sireet <br />EvereL, VJA 98201 <br />Phone: 2: 9'�3815 <br />Date <br />- 2 1 ' <br />. <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDG[MENT OF CONDITIONS <br />The undersigned ownedapplicant hereby agrees to hold and save harm- <br />less the City ol Everetl trom any and all claims for damages, costs, <br />expenses, or causes ol action that may arise because ot installation <br />and maintenance ot �he improvement or other right-ol-way use here�o <br />applie�for and turther agrees to remove same upon nolice Oom the <br />���y �r � to �eplace �� Pro�ty da�ed thereby. <br />Si ture ol Appliwnt - <br />Date <br />W K AUTHORIZED BY THIS. RMIT MUST BE STARTED WITHIN <br />18 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT nVER 90 DAYS DURATION. <br />z <br />0 <br />-i <br />� <br />m <br />.. ... <br />� T <br />�, _ <br />0 <br />m <br />co <br />m o <br />-i c <br />o� <br />m <br />s —�i <br />m <br />.o z <br />n —+ <br />rx <br />.. �. <br />—i cn <br />-� <br />� <br />oa <br />-n a <br />--I 'm <br />x <br />m N <br />or <br />c� m <br />C N <br />- N <br />m <br />� � <br />m <br />n <br />z <br />� <br />x <br />a <br />z <br />-a <br />� <br />N <br />Z <br />0 <br />� <br />n <br />m <br />