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Date y.'� �Y <br />ppplicetion For <br />PUBLIC: WaRKS PERIl�'19T <br />Print or 7ype Only <br />z� 3�a 5t. �►���5��� <br />a,��„« — cur <br />N� w 2�-5� o�.�� ' <br />Describe Proposed Work <br />FY i� <br />F�OLC WO�k9 PP�m�i � <br />eioo oeo�� • <br />Pubbc 1Vo�k5 Fe� S � �,� <br />Tota� Fee <br />�� <br />Lass Ro��� Fee Pnid s,�-- <br />Balence Due g � � � <br />�/.' f0 .�2 <br />z;v Gs�,azvp <br />t�� �n= <br />itv °ip Phona <br />- <br />y-Er�—SeANvK,s�f E��c.r�`�' <br />Prolect Address (il known) <br />Attach four�4) copies ot plans lor proposed work • Oraw �o sr,ale and note� Ce^�ie line ot stpeeii able: <br />• Property Lines • Indicate North <br />• Outline and dimensions of all ezisling and � ghow any proposed gradinp changes <br />proposed structures on the lot � ghow measuremen�s <br />• Ex�stfng and proposed ulilities <br />PERMIT CONDITIONS <br />1. All calls for inspr,ction shall he made 24 hrs. in advance - phone 259-881 5. <br />2. All work shell be pericrmed in accordance with this permit and current City of Everett Design and Construction <br />Standerds and Specifications. <br />3. Cell Location Underground Ser,rice 4B hrs. belore you dig. TOLI. FREE MUMBEH 1•800-424•555 . <br />� _.(� � �o< (��...--,�+�d' � c. �J4+ P�.H. �a f�SN�tr <br />-r 7PwG! IS 1 1 (� <br />sJ� �c �NP��� (Ir+C � SP��nrs�' pGf p..l>�.� W..r1.s stn..,Yw� <br />1 � <br />��.�%�..�.� �--o-6y <br />�� Date <br />Approved for Conslruclion <br />_ -' � �_ ii-� -.�y <br />�/-- , �- �u, <br />F�NAL INSP[CTION �a�� <br />ApProved as Cona��uctod <br />everelt PUBLIC'.VORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259-9815 <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />AGKNOWLEDGEMENT OF CC�NDITIONS <br />The undersigned owner/appllcant hereby agrees w hold and save harm� <br />less the City ol Everetl Irom any and all claims lor damages, costs, <br />expenses, or causes of adion Ihat may anse because of insta�latfon <br />and ma�ntenance o� lhe improvement or other righPol-way use he�e�o <br />aPPli d-lorertd therl 9�eope�rt� rdama9eA t ereby,n notice irom the <br />r��rf to reolaG� Y <br />-15��'Y—_- <br />Signalure o� NW��`:a��� <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STOFlTEO W�THIN <br />18G DAYF OP UHTE PERMIT IS ISSU[D ANO THEREAFTER IS TO <br />BE OILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF �NORK OIJ TF"S <br />PROJECT OVER 90 DAYS DURATION. <br />� <br />r <br />� <br />H r <br />y r. <br />H � <br />tn ^ <br />�� <br />�� <br />� �. <br />�� <br />�p r <br />Cy ; <br />M � <br />K' <br />O; <br />v,' <br />� F <br />�f <br />�; <br />Hl: <br />