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Date/��'� g6 <br />/ Application For <br />PUBLIC WORKS PERMIT <br />Prfnt or Type Only <br />O q Y'�C� /l�C��hP_ G� %r�f —�C� l�c.,f S/� /�l ��;/��� <br />Owner Meiling Address City <br />`J G <br />Applicant <br />A4ailin� <br />PUUuc Worte Pe�mll • �� L'f?� <br />eiea oro�.+ <br />PubGt Woikn Feo s <br />Toiel Fea <br />Lov AOVt Feo Peld a <br />ea�anceo�e S ��� <br />�r���..3r�-9'C�Sa <br />F'hone <br />[ip Nnone <br />Describe Propos�e{d. Work �`�`t^""� v' ��/� �C � r-'� S CJ `�� ��/ `� j n� s �� <br />� "� ys I .� � � / ON f ��!/.9Tt= �2c�fi�Y_'TY' C"Jif/L j/ � _ <br />—�-�--� i _ <br />Proiect Address (il known) ��� ��<'�/�i� ��C�' ��/!'�-(�� �^�n` — ` D �B�`-- <br />Attach four (4) copies of plans tor proposed work - Draw to scale and note the following as dpplicable: <br />• Property Lines <br />• O�tline and dimensions of all existing and <br />proposed structures on the lol <br />• Existing and proposed utilities <br />• Centerline of street <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be mad? 24 hrs. in advance - phone 259-881 5. <br />2, All work shall be performed in accordance wilh ihis permit and current City of Everett Design and Conslruction <br />Standards and Specilicationa <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•42v-5S�5. <br />7 `�' S�. /2o2-ZG-�Sl <br />w�' � ���1�� <br />�~ 5�"0. <br />^ � i <br />A��� 1- <br />Y, <br />�-� S <br />,nP/ <br />ti� <br />�E'c QG%�eG�s-, Er✓/�� <br />S �� �, ..-. , FI . C� <br />�� ���...:` <br />"J p yv�� <br />� <br />i��.���-- 5��9 BG <br />� Approved lor netruction Date <br />�� <br />��- �- �� -y� <br />fINAL�I SPECTION ���e <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8815 <br />z � ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />` <br />O <br />� <br />� <br />O <br />a <br />The undersiyned owner/apUlicant here6y agrees to hold and save harm• <br />less the Cily ot Everett from any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance ot the improvement or other righl•o4way use hereto <br />applied lor.a�urther agrees to remove same upon notice from the <br />City and�to repi, ce public properly damegLd. thereby. <br />��i%/ / / <br />� i � ,., <br />�- � � �� � ���, ����� .-=� <br />Signature of Applicant' Date <br />WORK AUTHORIZED BY THIS PERMIT MUST �e STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THERcAFTER IS TO <br />BE DILIGENT�Y PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TFi�S <br />PROJECT OVER 90 DAYS DURATION. <br />