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Date 7�� <br />Applicalion For <br />f'UBLIC WORKS PERMIT <br />Print or Type Only <br />naaress <br />zm <br />zm <br />Describe Proposed Work ���� �jZfOlt �G���ff J <br />Project Address (il known) <br />_ y Yh Di.r <br />Attach four (4) copies ot plans lor proposed work - Draw to scale and nole ihe lollowing as appl�cable: <br />• Property Lines <br />• Outline and dimensions ol all exis�ing znd <br />propcsed struC;ures on ihe lot <br />• Existing and proposed utilities <br />PERMIT CONDITIONS <br />Puolic works Pormpil �� �/ `-'y—�f�/7�j � <br />BICp.pePt�_CLI��%�QO✓-ID _ <br />Pu�l¢ WoiMa Fee <br />Toiel Fea S <br />LeSs AOOL Fea Pai� S <br />Balence Ouo $ �Q OO <br />• Cenledine of sireet <br />• Indicate Norlh <br />• Show any proposed grading changes <br />• Show measurements <br />t. All calls lor inspection shall 6e made 24 h:s. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with �his permil and current City ol Everett Desiyn and Construction <br />Standards and Speciticalions. <br />3. Call Location Under9round Service 48 hrs. betore you di�. TOLL FREE NUMBER 1-800•424•5555. <br />7= G•C'/�UE LOT SrJ A-r ,1lUT %O 1in�i9C i cSun�C'oUNOin/(� i��o�'E.('TES <br />S_ ncdNE� �C�ESf�pNSiB�s �oiz CLE"a�v-�r� O� ST,eEETS � <br />S:l�e=e✓AL.tS. <br />.1/� ..PEmO�ic' O.NC-.?ro/t m.%,'�:ei9 C G+� 6'Z�,c.r/ u//i-�emiT. <br />7 TE v.:'L✓�Si'c�/�T /.✓Yu SutTE'i� uINF,�'E' ./iPPG�Gf'idc£ <br />`-7 1/�IICi' �OL'���7� � � .��+ <br />Approved for Crnstructi n ale <br />� �� <br />FINAL INSPEI,TI�N Date <br />App�oved as Co�structed <br />evrreu PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259�88i5 <br />ACKNOWLEDGEMENT OP CONDITIONS <br />W <br />� <br />_ / <br />1 he untlersigned owner�applicant hereby agrees lo hold and sava harnr <br />less the City of Everetl Irom any and all claims lor damages, costs. <br />expenses, or causes ol adion ihat may arise because ol installation <br />and maintenance of ihe improvement or other right-ol�way use hereto <br />appl�ed lor and lurther agrees to remove same upon notice Irom the <br />City and to replace public property damxged thereby. <br />z�rGf�«., ss..,., �.��`c �- <br />'�v' �-r�.-s �L. _ �/`a v�,�� _ <br />Sig ature af ApplicaN `-` Datc <br />WORK AUTHORIZED BY THIS PERM11!T MUST BE STARTED WITH'N <br />1f30 DAYS OF DATE PE�MIT IS ISSUED AND THEREAFTER IS TO <br />�E DILIGENTLY PURSUED TO COMPLETION. THIS PERM'T MAY BE <br />CANCELLEO BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />