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Date�/ 5'(� ^ <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />mamng naaress <br />Describe Proposetl Work <br />Projecl Address 1if known) <br />F i<�-' s-. <br />� <br />l:iry Lp <br />auoi,c wo�k3 rermn .p <br />Blap Dept • //1 /.J�/,('G�f. _ <br />Puel¢ worYs fea <br />Tatdl F!! S <br />1e15 Nppl Fe! Ve�d S <br />BaianreDue S <br />Attach lour (4) copies of plans for proposed work - Draw to scale and note the lollowing as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all ezisting and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Ezistinq and proposed utilities • �how measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Conslruction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FHEE NUMBER 1•800-424•5555. <br />i <br />�O�1�t-c' lG>Oz./�-�j!�-�,�iuf�'ip�,/��r�t�c+��• <br />��CY.fi'6?/ ���C'7�2 ���..Pi �c� SECC�`C'r.i �%LC�2�L!/�v ¢�i�=.% C <br />/�'f [� / ` � J / �c • � <br />[!JL•U� ile.. .2i��G�G1tl� �.(� �C.'�(.nr�,R�=,�/[.;; %7l!<-LG2C�i�^`•d Lf% <br /><> <br />.S�li1�S�.c.•i,v �/,� � C�":�� 6� ZC,�tir L� ,tl�? 7u',�� a�ci:.tti�,� . <br />,:�� 1�/�77f't�l'2 <br />� U- -/� '%� <br />Approved lor Construction Date <br />FINAL INSPECTION <br />Approved as Consiructed <br />e�CrC(t PUBUC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Eve!ett, WA 98201 <br />Phone:259�8810 <br />W <br />� <br />� <br />� <br />O <br />H <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less Ihe City of Evereu irom any and all claims br damages, costs. <br />expen5es, or causes ol action ihaf may arise because ol installation <br />and maintenance of Ihe improvement o� other right-ol�way use hereto <br />applied for and lurthe� agrees to remove same upon notice Irom ihe <br />Ciry and to replace pu6lic properry damaqed Ihereby. <br />Signature ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS f0 <br />RE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CRY UPON ANY STOPPAGE OF WGRK ON THIS <br />PROJECT OVER 90 OAVS DURATION. <br />