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Date ��'�C 9�/ <br />y' <br />Application For <br />PUBLIC WORKS PERMIT m <br />x <br />Q <br />� <br />� <br />Print or Type Only �_ <br />a <br />CJ <br />CYP�P�P-� /'/YfG�i� SR✓%Nfl OdN�E �SU„2 W/YGL <br />Applicant <br />38oy QRG9D«yy <br />Mailing Address <br />c r� <br />r� <br />o b <br />C'J Cd <br />M i� <br />PUELC WmFe Permlt • / W / <br />Blap �eo�� • <br />Puohc Worte Fee <br />Total Fen s <br />Less Aopl. Fee ParC � <br />eaiance Due S � <br />f'v£RF7/' �vfj 9�ici „? s�-T�y�- <br />ZiP Phone <br />vE��i'��' wA . 98zc� .,Z S"o2 - 2/26 <br />Describe Proposed Work n��V�� of /Q00 Ci�LlA�7i �/f'TING Gjt T�yA,^- <br />�Pfiovq� � RPpLacrm£.✓� oF S��r �v9��(" U/Y IiYfST SlOE <br />Project Address �if known) <br />[C <br />iT W/� . A3o7G/ <br />Attach four (4) copies of plans for proposed work - Draw to scale and note the tollowing as applicable: <br />• Property Lines • Cenlerline of street <br />• Outline and dimensions of all existing antl • Intlicale North <br />proposed structures on the lot • Show any proposed grading changes <br />• Exisling and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspectbn ehall be mede 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pertormed in accordance with this permit and cu�ent City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424•5555. <br />�'� �rfi�rG S;dU.�..s��c �,- f,�b�,� ctJorl�f ,�+s�xcir.�r <br />C�,rc�fi� — ��,c� 339-7¢03 <br />�����;� y�LG/� <br />Approved tor Consiruction Date <br />-� �� _ 9..�r_ s•„ <br />FINAL INSPECTION <br />Approved as Consiructed <br />PUBLIC WORKS DEPARTMENT <br />3200 Cetlar Street <br />� Everett, WA 98201 <br />Yhone: 259�8870 <br />ACKNOW�EDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />� <br />� <br />a <br />The undersigned owneqapplicant hereby agrees to hold and savc harm� <br />less the City of Everett Irom any and all claims for damages. cosls, <br />ezpenses, or causes of aciion ihat may arise because of installation <br />and maintenance of the improvement or other righPof�way us� he�eto <br />applied tor and further agrees to remove same upon notice lrom the <br />City and to replace public property damaged ihereby. <br />��� �01�.�7 y-�U-,� <br />Signature ol Applicant 'Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />