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Date ���'-/� � <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />,U ,( �-.� a JD5 '�/�/ Cc�/�-/ <br />_ ._ �t <br />Applicant <br />� rvianiny naorese <br />r <br />`� 'i'/�ll��Iii��� <br />Mai�ing Address <br />1 <br />��, I �uM�c worka Parmn + <br />� BiGg DeD� � — <br />Pebl¢ WpfkS ioe <br />Totnl Fee s <br />Less Rnpl ine Paid S! - <br />�dlpl�[I! �JP. i <br />)p� c--� k��,-,> 'iS�?r�; <br />c�rv z�o <br />� <br />:-�5.._J -/J �/ � <br />Phone <br />" l .;� / �/S <br />DescribeProposedWork I�� /9C E 7N� �l���l-STC'� C/�-%%��- S"T,e �l � <br />f ��,C' ��Q'�/,cY' . � u� y a� r�� � u 7 v c v 3� — <br />Vro�ecl Address (il known) <br />Atlach four (4) cop�es of plans for proposed work - Draw In scale and note Ihe lollowing as apUlicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions of all ecistmg end • Indicate North <br />proposed siructures on �he lot • Show any proposed grading changes <br />• E.isting and proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shell be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accordance with this permit and current Ciry of Everett Design and Construction <br />Standerds and Specifications. <br />3. Call Locetion Underground Serv� 4B h�s. before you dig. TOLL FHEE NUMBER 1-BOO-424•5555. <br />l�U MY'S�f� �f�A�t r3L- (=c �i:�.c-Q 6N ��ifi <br />��r t� t�T N O"r L Et. 5 T ti n� � o (�� -r �� O M <br />'�11 F Cm R N�`I� D F y� rtt ii �1 � W 1� wt i NGTz �tJ <br />Ibr <br />FINAL INSPECTION <br />Approved as Constructed <br />everetl PUBLIC WORKS DEPAHTMENT <br />� 3200 Cedar Street <br />Everetl, WA 98201 <br />Phone:259�8810 <br />'' / —� <br />_ ;� � <br />Date <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less ihe Ciry of Everett irom any and all claims for damages, costs. <br />ezpenses. or causes ol action Ihat may arise because of installation <br />and maintenance of the improvemenl or other right-ol-way use hereto <br />npplied tor and lurther agrees to remove same upon notice irom ihe <br />City and to rep�ace pubGc pwperty damaged thereby. <br />.. �r� _�. 1 ' <br />i / <br />� �/ <br />� � ir�_ �L-� ��[--r—ch � i� - i��/ . <br />Signalure ol Applicant Date � <br />�.� WORK AUTHOR12ED BY THIS PERMIT MUST BE STARTED WITHIN <br />� 180 DAVS OF �ATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />