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Date�/' "/ <br />ApP���ation For <br />PUBLIC WORKS PERMIT <br />Print or Type Only , <br />—!��AMcs scrdcb�E�ilinAAddre9�n U-�s <br />....-- <br />Address <br />a�„ z�a <br />�.Ily �-�M <br />sY ,� 3 <br />VuElic Worke Perm�t • <br />6ldp. Deo�� • <br />PuElicWork�Fee s �{).[]Q <br />Tot�l Fee �. <br />Lase �oG� Fee PeiE f <br />s 3Q (J (] <br />B�I�nce Due <br />� ,�i 7%O� <br />DeacribeProDosadWork =��T�L � �PL'zT ��ZL F�yG�+ — <br />Project Address (il known) <br />At�ech lour (4) copies ot plans lor proposed work • Draw to scale and note � CQ°�;e�line ol sipeeii able: <br />• Property Lines • Intlicate North <br />• Outline end dimensions of all ezisting and � Show any proposed grading changes <br />p�oposed atructures on ihe lot � ghow measurements <br />• EKisting end Froposed utilities <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8815. <br />2. All work shell be peAormed in accordance with this permit and wrrent Ciry of Everetl Design and Consiruction <br />Standards and Specifications. <br />3. Cell Localion Underground Service 48 hrs. batore you dig. TOLL FREE NUMBER 1-800'424�5555. <br />.� <br />/ � b � �. ,..e.., �.., _ � � �l z �,; � I� <br />l �Q,I -��<< <br />S, 1'�0�1-- �,,.,w�1-- b� <br />{p • <br />-iree-t' � �^^ <br />�-�T'%��i�awl- r�co5h.irs <br />C:�l.� �c/,,,� a., 9 <br />� �ec9 �� <br />. . � a (a,�,o � <br />� w,..�.►sa,»„ ...,� B- <br />ed�� � e-n�s�d,Ha <br />�N <br />NPN� <br />�P�n c�' <br />`J"-C� �`�i 'Y E Nt. Q <br />� <br />Powew�r��--� <br />/�� A. [ r..i� <br />`i-1'lnY� 5�......1� "t�� �+Jly ;�.: `}�e � i'u.Il')' <br />1 (� �`l- I- <br />H%�C�P�. V�4. �'X1S�1N` (ofaliwri �"1�"� <br />/� J (� 1 ,�,e <br />\oea✓`�:"v e1.�Pv�Sf O�t' (Pw�ov�v� c„^�J �P1�caR-��-:\ <br />�� <br />�� ..e<�.�9. <br />I S LN <br />bP <br />W <br />H <br />� <br />N <br />`—�„�-� ��� S-i� =fY <br />A�oved for Construction Date <br />//_�� r'-"�� —�`1?-�y — <br />.F� INSPECTION Dale <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTME�7 <br />� 3200 Ced•,r S�r:�! <br />Everett, NA 98201 <br />Phone: 259-li915 <br />� <br />0 <br />ACK�OWLEDGEMENT OF CONDITIONS <br />The undersigned ov:nei/applicant hereby agrees to hold r.nd save harm- <br />less lhe Ciry ol Everet� irom any and all claims for damages, costs, <br />ezpenses, or causes ol action ih31 may arise because ol installation <br />and mainlenance ol the improvement or o�her righFol-way use hereto <br />applied lor and Wriher agrees to remove same upon notice irom Ihe <br />Gty anA to replace public property dameged thereby. <br />' ature ol Applicant Da�'� <br />IWORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUFSUED TO COMPL[TION. TFIIS PEHMIT MPY BE <br />ICANCELIED BY THE CITY UPON ANY STOPPAG[ OF VJORK ON THIS <br />PROJECT OVER 50 DAYS �URATION. <br />