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Date n'?� -� �� <br />AppliCeticn FOr <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�� <br />F / Gul c.n1 i <br />Mailing Adtlress <br />Descnbe Proposed Work ��L`� C� <br />Prolect Address lif knownl <br />OubhC WC•�f �Tmi1 • <br />6mq Deo� • _ <br />�uei4 N'ons Fqe s <br />Taiai rr< <br />L<ns�pp: F!<PpiE s <br />Baunce Oue S <br />" 9�;� <br />Zip P <br />�a,2. L��/.c�. �u �y �Sr �r�r�eu Tu �v 31 <br />Attach four 141 copies ol plans br propo5e0 work � Draw to scale and note ihe tollowinq as Tpplicable: <br />• Property Lines <br />• Outline and dimensions of all existing antl <br />proposed structures on the lot <br />• Exisfing anC propo5e4 utilitie5 <br />• Cemerline of street <br />• InCitate North <br />• Show any proposed gra0ing changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hra in advance • phone 259$810. <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction <br />Stantlartls and Specificationa <br />3. Call Location Underground Service 48 hrs. before you tlig. TOLL PREE NUMBER 1-800�4245555. <br />V�(Hi�S��T S11ALL �9� ��ACcq bl1? yl�rtf <br />S� �T A.� C'T 1. t35 i N�9 n.� 3D FE�"t F�.P ti( <br />�ftC- C.r�N�-f'. OG �g;}t A�;� ���1�ftiNGiZ!�,) <br />r <br />! <br />�_�z � . � _-�/ � - ,� 1 �� <br />�oorov�a fbr Construet on Date <br />FINAL INSPECTION Date <br />Appfovetl as CO�S�rUC�2tl <br />everett PUBUCWORKSDEPAqTMENT <br />� 3200 Cetlar Street <br />Everett WA 99201 <br />Phone: 259�8010 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />� <br />sa-/�IS— <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned owneUapplicant hereby agrees to hold anC save harm• <br />less the C��ty of Everetl from any and all claims lor Camages. costs. <br />eaoenses. or causes oi action that may arise because of installation <br />and mamtenance of the Improvement or other right-ol-way use hereto <br />aoplied lor and !unher agrees to remove same upon nouce from the <br />Crty antl m replate�nbhc propeny Camaged thereby. <br />l � � � <br />� / /� / i <br />i(G....—. A�c-..r:�tl�! / r'�;.'fY/ j%[. <br />WOFK AUTHOR12ED BV THIS PERMIT MUST BE STARTED WITHIN <br />190 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGE4T�Y PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAVS DURATION. <br />