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DateT/9_�3 <br />qpplication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Owner <br />Describe Proposed Work <br />S7s L � �u� �iJ e�eel <br />Mailing Address Cily ZiP <br />Maiiing Address Cily Zip <br />.!' 1� e� S� �C .j � X/�` f A�� <br />s�o� o�h= <br />5 0. <br />Project A ,dress (if known) <br />Attach four (4) copies ot plans lor propoeed work • Draw to scele and nole � Ceo�ie�^' `�e ol strepi; able: <br />• Property Lines • Indicate Norih <br />• Outline and dimensions ol all ezisting and � ghow any proposed grading changes <br />proposed struclures on lho lot � Show measurements <br />• Existing and proposr.d utilities <br />PubliclPo�ksPerm�1+ � ' I � <br />Bl�y. Deoi. • <br />PUELCWmksFee �� �� <br />Talal Fea $ � <br />less Aoo� Fee PaiE a � U <br />Ba'.ancc Doe <br />$ oZn � <br />Z'�Z - l3 r 8� <br />rnone <br />PERMIT CONDITIONS <br />1. All calls lor inspection shell be made 24 hrs. in advance - phone 259-881 5. <br />2. All work shall be perbrmed in accordance with ihis permit and current City of Everett Gesign and Construction <br />Standards and Specilications. <br />3. Coll Location Underground Service 4B hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />,//� 1 1 1 O �o ,-- •� e <br />M (��rrnce w1KS� �C' SC'.*'�0.C{L - <br />So wF-� 1S'tl�n,�' —�o t' <br />(INe N T �AVeNv�4 5��. <br />( 'S-� cz� �, <n.r s �., V� �e�d � �e C'x�s�na <br />� <br />l,a�se �s n�l.� se!- b0.�1� 3'� �.._ -�-� <br />�Ve�n...� S•i.- �'�y�..� -c�i'- wac p�v.�Y !'�`/��— <br />�i«S•i1N ( O 1� c3ara �C �.$ �KS'� iNa.L�tc.J` <br />.�.o.�u� ,� <br />� <br />�'K <br />�, S �,,,d- o W��. <br />! <br />_.�/ �!� �_-�3 �'3 <br />Approved tor Const r,Lon I r Date <br />j� � d `� �,- o � <br />C��nSe �l�e _' ii,,,.� eoKs �..� <br />FINAt'IF15P£CTIflN K%�� �7� <br />q ucted <br />everett PUBLIC WORKS DEPA TMENT <br />� 3200 Cedar SVeet � <br />Everelt, WA 98201 <br />Phone: 259�8815 <br />S <br />Z <br />O <br />� <br />V/ <br />0 <br />a <br />2.i�lS�IK� �0.VP�"�c. Sy— <br />ACKNOWLEDGEAIENT OF CONDITIONS <br />The undersigned owner/applican� hereby agrees to hold and save harm- <br />less lhe Ciry ol Everett irom any and all claims lor damages, cosis, <br />expenses, or causes ol acticn that may arise because ol installation <br />and mairdenance ol lhe improvement or other right-ot�way use hereto <br />applied lor and further agrees to remove same upon notice from lhe <br />Cily and to reFlace public properly damaged ihereby. <br />-- � 7 �. <br />r <br />"_ ,,-'r:_. ( .:"i��-- • �'.. - <br />Sic�nature ot Applicant Oate <br />WORK AUTHORIZED BY THIS PERMIT MUST B[ STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEH IS TO <br />QE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />