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/, <br />Date � <br />� � Application Fo� <br />PUBLIC WORKS PERMlT <br />Print or Type Only <br />Applicant <br />C�� f —,/Y's,-G /\l�l� �1 klcj 1 <br />ii ng Address <br />li <br />Alailing Address <br />Puo>c'.voiFs pormii s �—��.1�/�'� � <br />Biap oco� � � <br />PuoTolal FeeFee S ��/ ' <br />Less ApO� Fee Pald $ <br />OdIOnCC �110 .S L� <br />u i� <br />1� Sl�C 1-Ic�(`�1i <br />City Zip Phone <br />Describe Proposed Work ��r�J I l—Y� �� �LQ ' <br />' SE'W�.i2. C-UfJfJL�G'r�OrJ <br />' la�!'�tY1. nr �2�-h.1-r- �,�n� \n�.�t_i_� � <br />r <br />Project Address (if known) ? <br />Attach lour (4) copies of plans for proposed work - Draw to scale and note the followinc� as applicable: <br />• Property Lines • Centerline of streel <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Exisling and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 2a hrs. in advance - phone 259-A815. <br />2. All work shall be perlormed in accordance wilh ihis permit and current City of Everett Desic�n and Conslruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />�; �.�z.,- �-%�%�.a�� c� /� ��e�,-�- �/,,le � �� �3 <br />.5 , LnSL� �� S�c,✓�C-=�� /«Q�� �� �Or�cJ f T� �i-z � c�/ /`r'�_ <br />Sr�� ILFi� L . / � <br />� � �. <br />,I�J E �,, I _ <br />� (�/eG <br />�� � <br />/ <br />Q t� <br />W <br />� <br />� <br />�� <br />� <br />� <br />O <br />� <br />� <br />Y � P / �/' <br />� � , , ,.e � <br />//'1��- , <br />_�i�� l i - - J� i <br />V, �y•-� <br />.� <br />i <br />� <br />' i <br />, /. 3 � <br />, i�_/ cy <br />Apprd ed Im` onsiruction p;��� <br />` <br />�� FINAL INS ECTION <br />Apprpved as Constructed <br />everett PUBUC WOFKS UEPARTMENT <br />� 3200 Cedar Street <br />Everetl, WA 98201 <br />Phone:259-8815 <br />Date <br />,�Osf �� 1 'i�- c.- / p '�'3 <br />�� �� • <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersi�nco owner/applicant hereby agrees to hold and save harm� <br />less the City o' Everatt from any and all claims lor damages, costs, <br />expenses, or causes ol ar,�ion that may arise because ot installation <br />a inlenance ol Ihe improvement or other righ�•of-way use here�o <br />a pl ed r and lurther a�rees in remove same upon notice Irom the <br />City 3nd t replace puh�jc proPerty damaged therehy. <br />sign Wre ol Applic nl'" � — Date <br />WOR AUTHORIZ D BN THIS PE MIT MUST BE STARTED WITHIN <br />180 GAYS OF DA E PER�11T S ISSUE6 AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO�COMPLETION. THIS PERMIT MAY BE <br />CANCELLED 8Y THE GTV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />�1 <br />J <br />� <br />