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_ � �,'I>: <br />pate i � <br />� <br />PUB�IC <br />O <br />O <br />Application For <br />WORKS PERNIIT <br />Print or Type Only � o 0 <br />�- vi vi <br />� w � <br />,.� ,_ ,.h�.,ti\ <br />0 <br />Describe Proposed Work <br />. n -_ <br />Projecl Address (il known) <br />l�.--2 ✓ C �' C�J \•, ,., C <br />Mailing Address C 1C Z ZS City <br />J <br />� � / 6`� `i r� ii�.�•/ <br />Mailing Address i�Y <br />- '� x �`� ��� �s <br />J-N <br />� <br />PupLc \Yo�k9 Pmmil • �/ � /� _ <br />91tlg DeOt • <br />P�hlic \Yorks Feo � <br />Total Foe <br />Less Appl. Pee Pei� S(� <br />Oalance Due S L �'��O <br />Da2-312- S�a-Oo0 -/Z-�3/ <br />bry <br />c,�,.,0��, <br />�ti <br />- �v� ����3 0 35'y ; s� <br />Zip Phone <br />Attach lour (h) copies of plans tor proposed work - Draw to scale and nolc the lollowinc� as apP��cable <br />• Property Lines • Centerline of sireet <br />• Outline and dimensions ol all e�.is�{ng and O Indicale Norih <br />proposed structures on �he lot • Show any proposed gradinp Ghanges <br />• Enisting and proposed u�ilities • Show measurements <br />NOT <br />PERMIT CONDITIONS <br />1. All calis lor inspection sha�l be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be performed m accordance with ihis permit and current City o� EvereU Design and Construction <br />Standards and Specifications. <br />3. Call location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1-800•42•3-5555. <br />�il, f�w�fa-c.F �i� Y�'"6 �u. tvns�a- ,/n.,f.�c.e.� v�2c vz .�o Qr-�'<=..� <br />Lvaz.�- <br />.� ..%1���w C'r.r�u��0'2aCv.�Lc.�w -C'an ��� �LoC�c �Ua.C� S7� <br />(O. �L c r. �Ctc'r� .�'ze-r�c�i �C.cl-c-nC'F� /2eQ�Yctcn+� ./2.;a.�nft�.v _�.fi� <br />'%YJ4.�-ClU �O�sC�l�[. /.Z�C7� 4n"[�� Q1,%/!a-L�i'�� 07.�C�� <br />7. ScL<✓ e.<c-Yf �tu.ce.,1.c.,.'t`'�n.�.� ./�.:.e -C�>rri-Y.c-�C��cO c�o,.v�-i,� L'�:.c.(�i C'/- <br />B, SP�I' .fsoeCi [L'ClJG �J�E' ��OL>L%. <br />�./����- i �� <br />Approved lor Co str tbn Date <br />�/'�' '� ��—l�`/ " / �� <br />FINALINSPECTION �� �a� <br />Approved as Construded / <br />«,���❑ PUBLIC WORKS DEPARTMENT � <br />� 3200 Cetler Slreel <br />Everett. WA 98201 <br />Phone:259�8810 <br />ACI<NOA'1LEDGE�"ENT OP CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />�w <br />_ / <br />O <br />a <br />The imdersigned owneUaPplicant he�eby agreFs to hold ar 1 savc harm� <br />less the Ciry of Everelt Irom any and all claims for dailages, costs. <br />expenses, or causes of action Ihat may anse because of installation <br />and maintenance of ihe improvemen� or o�her right�ol-wav use hereto <br />applied fo� and uriher agrees to emove same upon notice irom thc <br />Cily and� r_ 1�7ce public pro�damaged ihereby. <br />.�-� ���/.,� /-/� �/ <br />ic�nalure of Applican Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUEU AND THEREAFTER IS TO <br />8E DILIGENTLY PURSUED TQ COMPLETION. THIS PERMIT MAY i3E <br />CANCELLED BY THE CITY UPON ANY STOPPAG[ OF WORK ON THIS <br />PROJ[Ci OVER 90 DAYS DUR�TION. <br />