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Date2YLL�3-"—�U � l�" � <br />Appliwtion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />qpplicant <br />Describe Proposed Work <br />Project Address (if known) <br />0 <br />Attach tour (4) copies ol plans lor proposed work - <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed strudures on the lot <br />, • Existing and proposed utilities <br />��NI�- Ft��t�, <br />z� n+ <-� <br />res���ty <br />_ ooF�2 N� <br />___„ City <br />Zip <br />Puenc lVoiks Pormu • /v— O <br />Bidq DeO�-' � <br />Ly-- <br />Publlc WorkS Fee 5 <br />Toial Fee <br />Less ApD�� Fce Peid S i--�– <br />Balance Oue <br />$ �! <br />Draw 10 scale and nole the tollowing as applicable: <br />PY�one <br />Phonz <br />�z��t -�i 55'% <br />• Centerline ol street <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measuremenls <br />PERMIT CONDITIONS hone 259•881 5. <br />i. All calls lor inspeclion �hall be made 24 hrs. in advance - p <br />2. All work shall be performed in accordance with this permit and current Ciry of Everetl Jesi�n antl Construction <br />Standards and Specitications. <br />3. Call Loca:ion Underground Service 48 hrs. belore You dig. TOLL FREE NUMBER 1•S00•424•5Ei5 . <br />�� Yo,�lG jJ (``"'`� �� f c� d ��L/-� <br />l,�, �,rt'ii� �tl-'�- <br />/� <br />, ��j _ ,� -� <br />Date <br />qpprpv for Con:Aruction � � ��/ <br />"_ %� � .� .�---- � /"J " l' <br />j% i ` / � f <br />�— uaie <br />FINAL INSPEGTION <br />qpproved as Constructed <br />everett P�BLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everett. WA 98201 <br />Phonc:259-8815 <br />W <br />H <br />- <br />� <br />� <br />O <br />� <br />Y/ <br />� <br />a <br />�CKN04VLEDGL=PdENT OF CONDITIONS <br />i hp undersigned owneUapplicant hereby a9rees to hold end save harm� <br />iess the Cdy of Everett from any and all claims tor damages, costs. <br />enpenses, or causes ol aclion lhat may arise because ol installalion <br />and maintenance ot the improvement or other righl-ot-way use he�eto <br />applied tor and lurther a9rees to remove same upon notice irom the <br />City and to replace pu6lic property damaged thereby. <br />%G�/ 1t�� � � �dpate <br />Si ature of Applicant <br />7JgORDA STOFRDATE PERMIT ISE SSUED AND HERA AFT�ER ISHTO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />G�NCELLED BY THE CITY UPON AIJ1' STOPPAGE OF WORK ON THIS <br />PROJECT OV[F 90 DAYS DURATION. <br />C <br />� <br />., � <br />�. <br />N . <br />OCr <br />[*1 � <br />�F <br />� h_ <br />r <br />� �. <br />t" �. <br />H� <br />H [: <br />K <br />O; <br />� r. <br />C <br />t: <br />- c, <br />: <br />• � <br />