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.i: <br />Date� �`3^�� <br />� ���i Applica�ion For <br />M <br />PU�IC WORKS PE�MIT <br />O <br />O <br />Print or Type On <br />Applican� <br />00 <br />00 <br />N N <br />W M <br />5�> <br />=��a � <br />�� � Mailing Address <br />• U <br />M WS <br />CLL] U <br />Mmlin9 Addiess <br />-►�Z <br />Describe Pwposed W`o1rk �✓ �V �� �i"� �C�' U�1 <br />t�� � c� QTTG1 %� l, ?'f.���Q �]3L"J <br />f,c,5� on Cemenfi a^�-�sn. _ <br />Project Address (il known) <br />—�JrC P� �E <br />v�ei�cwo��sr��m�i. 9D—.�G 5.c <br />9i0B Dept • <br />Pupl�c Wor�s fce <br />Tolal Gee $ __ <br />Less Anol fec Pa�� $ � <br />�' <br />r,i.,��eo�� S v <br />y 2ip <br />y Zip <br />r�' � D��c�ta[. <br />:s�r��a I ra��s � <br />F��/E rz a-fi �- <br />n�� 9�3� <br />Phone 7 <br />Phone <br />�a- u90(�`i <br />_ __ J � I I . _ _ <br />Attach lour (4) copins ol plans lor proposed work - Draw to acale and note tne lollowing as applicable: <br />• Property Lines • Centerline ol streel <br />• Outline and dimensions ot all existing and • Indicate North <br />proposed siructures on the lot • Show any proposad grading changes <br />• Existinq and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shell be perlormed in accordance with this permit and current Ciry ol Everett Design and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�i �L,� t ..5���' /ze iu�,z.ec� Q.; � �'w�E�r�G..-oe�-� <br />� �/�aJ OZJ�zeit/ •ai,.o�� �-�%J t'�L� ..Eu� n �a.ed' <br />�z`D �vozl� .�.; �it'�i a/�e�• ,%�i G�"� .a1�C''� <br />6E � p����'� �-� �� �%�� �'a �.� <br />�:�y 2.�;1a.t� / r/ �'/iti r'2.zr�. <br />O �� <br />lor <br />FINYcI INSPECTIDN�� ''� `l� <br />ApproveA as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Evcrett, WA 98201 <br />Phone:259-8810 <br />�y <br />• <br />� <br />O <br />� <br />� <br />� <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undereigned owneqapplicanl hereby agrees to hold and save harm� <br />less the City ol E�erett Irom any and all claims tor Aama�es. costs. <br />expenses. or causes of action Ihat may arise because ot installaUon <br />and mainlenance ol Ihe imProvement or other right-ol�way use herelo <br />applied lor and lurther agrees to remove same upon no�ice Irom Ihe <br />Cit and to replace public property damaged thereby. <br />� , �-r�n' � /31 /50 <br />Signature ol App i ant Date <br />WORK AUTHORIZEO BV THI ERMIT MUST BB STARTED WITHIN <br />180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENiLY PURSUED TO COMPLETION. THIS PERMIT �.1r1Y B[ <br />GANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS . <br />PROJECT OVER 90 DAYS DURATION. <br />