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�8�e.���jf�Q <br />_�. � <br />Appllcntion For <br />PUBLIC WORKS PERMIT <br />Priiit or Type Only <br />6era�c� F� l�f�kE'�' ��!35 <br />Owner Mailing <br />Ge�� E, �3Rk�Z �r73S <br />Applicant Mailing , <br />Describe Proposed 1Nork /v�W (j <br />Project Address (if known) �3�5— <br />Attach four (4) copies of plans lor proposed work - Draw to scale and note the lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed slructures on the lot <br />� Ezisting antl proposed utililies <br />Pu�l¢ Wpiha Permit � v ✓ —�+�0 <br />BItlO Dap1. • �� <br />Puolie Wode Fua <br />Tolal Foe s <br />Lo54 Appt Fae PniC s� <br />Dalnnce �ue S ��� <br />• Centerline ol street <br />• �ndicale North <br />• Show any proposed grading changes <br />� Show measurements <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hr�, in advance • phone 259•8810. <br />2. All work shell be performed in accordance with this permit end current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Coll Location Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />I, te�� /.'�-���f��nc.�'.e/ �on�S�7.i/ ��` <br />JD�.cJ � a.r�m�z ..t�uuc�vay, -a-� .�. <br />O <br />S ��.,��p, <br />o� �a�f <br />,u��,r-o.��-�,q4 � �¢/our�-� <br />,d� �i di�.cc�ccva.�; <br />6 <br />�/� <br />� 3- <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Ceder Street <br />Everelt, WA 98201 <br />Phone:259-BB10 <br />Date <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />O <br />The undersigned ownedapplicant hereby agrees to hold and save harm• <br />less the City ot Eveiett Irom any and all claims for damages, costs, <br />ezpenses, or causes of action that may arise because ot instaliation <br />and maintenance of the improvement or other right-of-way use here�o <br />applied lor and lurther agrees to remove same upon notice irom ;he <br />Cily and to replace public property damaged thereby. <br />���l.u� �-�l G -�' <br />Sigrfilure o A plicant Dale <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PER�71T MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WURK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />