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Date��� <br />Application Fcr <br />PUBLIC WORKS F�ERMIT <br />Print or Type Only <br />Mailing Atltlress <br />Describe Proposed Work <br />7V <br />Proiect Address �il known� <br />AtlOfQSS <br />cny <br />a„ni�c �+'o�ws r��mn . <br />g�y/ -� z . <br />siaq Ueot+ E' � <br />PubllcWo�klPOO S, <br />Totel Fee - <br />LessApO�FeoPeia � %% <br />BdIPnCP OOP. � ?�/" �t <br />�0� 9 <br />up rnone <br />AUach bur (4) copies ol plans lor proposed work - Draw to scale and note the tolloH�ing as applicab�e: <br />• Property Lines • Centerlme ol street <br />• Outline and dimensions of all ,�alsting and • Indicate North <br />n�oposed sL uctures on the lot • Show any pwpo:ad giading changes <br />• Existing and propo5ed utilities • Show measmrm.anis <br />PERMITCONDIfIC'NS <br />L NI calls lor inspeclion shall be made 24 hrs. in advance - phone 259•881 5. <br />t. All work shall be performed in accordance with this permlt and currenl City of Everett Design and Construction <br />Standards anA Specilications. <br />3. Call Location Underground 3ervice 4p hrs belore you dig. TOLL FREE NUMBER 1•800•�324•5555. <br />�,,,,� ��.,.� p/,�/'s� <br />Approved lor Consirudion �� �e�e <br />-� 1 <br />�3 '� <br />(`��' \�r�.;�_��>. �'�/ <br />FINAL INSPECTION l 1 �� �� Date � <br />Approved as Consiruc�etl- � <br />everett PUBLIC WORKS DEPAATMENT <br />� 3200 Cedar Slree� <br />Everelt, WA 98207 <br />Phone:259�8815 <br />ACIWOWLEDGEMFNT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />� <br />The undersigned owneqappliwn� hereUy agrees to hold and save harn� <br />Icss the Ciry ol Everell Irom any enA all claims for damages. cosis, <br />expenses, or causes ot action ihat may arise because ot installaCon <br />and maintenance of the improvement or olher right-of�way use herelc <br />appfietl-lo and luriher agrees to remove same upon no�ice from ihe <br />�ity a to placc public propeny dam�ged iherebp. <br />�� � � � <br />Signature <br />%'-�S �, <br />Da� <br />WORK AUTHORIZED BV THIS PERMIT MU� ST4RTED WITHIN <br />180 GAVS OF DATE PERMIT I;i ISSUED AND HEH[AFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPL�TIO'N. THIS PERMIT MAY BE <br />CANCELLEC BY T�E CITY UPON �NY STOf PAGE C�F WORK ON THIS <br />PROJECT OVE:t oJ OAYS DURP,TICIJ. <br />z <br />0 <br />--I <br />C� <br />m <br />M 1"� <br />-{ T <br />�--i .--1 <br />Vf S <br />m <br />co <br />mo <br />n <br />0 3 <br />� <br />i —zi <br />m <br />.. <br />cz <br />D --I <br />.r. � <br />--� v <br />< <br />o �. <br />-� 7_, <br />T <br />�. . <br />or <br />�r <br />cv <br />3 � <br />m <br />n <br />� m <br />n <br />:c <br />➢ <br />:T <br />V <br />L <br />�� <br />r <br />r- <br />