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Date n/�� �i- <br />Application For <br />PUB�IC WORKS P�RMIT <br />Print or Type Only <br />�� <br />Address <br />� <br />ann��c Wcrvs ['e�mu s `� " _ <br />Biop Oeol. � _ <br />aoei¢Wo�kaFee s <br />Total pee <br />lPef Rppl Po! PnU S n <br />eai�nce Due f f D' n� <br />.�EC. �t 7oB%/ <br />Zip Phone � <br />J�n✓a.�sc�� <br />l�.r7/�/ 7Sf1_ 5/ ,/, r% <br />Applicant Mailing Atldress � C1ty Lp Phone <br />Projett Addre�51i1 known) <br />A�taCh �our (4) cC7ies of plans lor proposed work � Draw to scale and ncte the !ollowing as apP��cable: <br />• Property Lines • Centerline ol st�eet <br />• Outline and dimensions of all existing and • Indicate Norih <br />proposed siruclures on ihe lot • Show any proposed greding chanyes <br />• Ezisting and prOposed utilities • Show mea5urements <br />PERMIT CONCITIONS <br />1, All calls lor inspection shall be made 24 hrs. in advence - phone 259•881 5. <br />2. All work shall be performed in accordance wi�h this permit anA current Cify ol Everatt Design and Construction <br />Standards and Specilications. <br />3. Gall Location Underground Servics 48 h�s. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />� r��5,�11 bc:rr�c�,cler a..� ;�S�n�r � �los` <br />��c�Pw.•.1�� �� <br />of' ��e h.�.��;� <br />�!d's . �o �1-�.e �>a� is�ac�.o.:. <br />w���k s —L,,, s�, e,•-%r <br />/ <br />_,�...�.���_s���y <br />F.pproveA lor Construc�ion ,� � Date <br />/i <br />FINAL INSPECTION <br />Approved as Construcled <br />everett PUBLIC WORKS DEPAFTMENT <br />� 3200 Cedar Street <br />�Everett. WA 98201 <br />Phone:259�8815 <br />W <br />H <br />� <br />� <br />ACKNOWIEDGEMENT OF CONDITIONS <br />The undersigned owner/apphcant herehy agrees to hold and save harm- <br />less ihe City ol Everetl Irom any and all claims for damages, cosis, <br />expenses. or causes ol acfirn that may arise because ol mstallation <br />and maintenance ol the improvement or other right-ot-way use hereto <br />applied for and lurt�er agrees to remove same upon notice Irom the <br />CiN and-Fe�-rcplace public erty amaged ihe�eby. <br />Sig ure ol ApplicaM � �a�e <br />W RK AUTHORIZED Y THIS PERMIT MUST BE STARTED WITtiI1J <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIG[NTLY PURSUED TO COMPLETION. THIS PERIdIT IdAY BE <br />CANGELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br />PFOJECT OVf R 90 DAVS DURATION. <br />