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oeta2.�Y <br />Applicetion For <br />PUBLIC WORKS <br />Print ar Type Oniy <br />Describe Proposed Work <br />Mailing <br />A <br />Pu�Lc Wo�b Pe�mit • � � ZP� <br />eiao oso�� • � 7 <br />PERMIT Pu�ImWorkeFee S��.O(7 <br />TotalFee <br />Leas Appl Fa0 Peid S <br />Balance0ue S "��'� � <br />% %/U <br />Ury <br />Project Address (il known) v -' ` `� "" " ` - <br />Af�ach lour (4) copies ol plAr,s lor proposed wo�k - Draw lo scale anA note the lotlowing as applicable: <br />• Propart� Lir • Centerline of street <br />• Outline anc �imenaions ol all existing and • Indicate North <br />proposed sirucWres on the lot • Show any proposed grading changes <br />• Ezisting and proposed util�ties • Show measurements <br />PERMIT CONDITIONS <br />1. Ail calls for inspection shall be matle 24 hrs. in advance � phone 259•BBl 5. <br />2. All work shall be periormed in accordance wilh this permil and curreni City of Everet� Design and Construction <br />;:tandards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />�. 1`{�\NJ�C /i�n✓' fL�ICiCCC GO.�+/J1f_`C S\�PW[\IIL. P�nIY CNrJ G lNI-IC�� <br />\ 1 � 1 1 <br />Sl' �(��.J'.� \+� (�/.f�Cc. p� .�f..✓ Glf.�CWGN J 1J0`i-� ta.clfr...-IIt <br />�.r`, (N(p 11�n8' CNfIII W\H1�� "'C SG�-I.,,s� o� re...-.a..,�.� ,v <br />l <br />v�ta��c} Nt`(>ans.d... ��c��..'�'Qrr Scn. 3.3.�7 oF CucaeH i�.,���� <br />Vu,,;.�s 5�1JS. <br />S. 1�1r,,..�Ir..,<w�_���.Q s:��e..�.,.11� � 1�n_ "..��-..�I�.�Per 5���3�-7 <br />%. C�w..er .`oi <br />Jp� 5.1e <br />���a,�� <br />� <br />O <br />�w <br />_ / <br />f �.o��,� «� �,�. a <br />Co,�`Yrnc�-oi ���.o.11 c./'rnr.cJt .- I J _�, � <br />.n.Ll II Q Q..b��c 1.vc�iS 1.n7�JCcdvi �r,U.� <br />Yt^ �fN <br />G...�;J �f^��.�AIS <br />� <br />� —> /.. <br />-r��,�� �" r z �_a�. <br />� atc <br />Approved for Con5lruction � / <br />��"' �( �/�.1�� " �' -/ 1/ if� <br />%FlNAL INSPECTION Date <br />Approved as Constructed <br />everelt PUBLIC WORKS DEPARTh1ENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phonc�.259�8815 <br />O'� (?wSY1N lv-�)(OJe���w4-1.. <br />ACKNO�LEDGEMENT OF CONDITIONS <br />The undersigned owner/app�icant hereby agrees to hold and save harm- <br />less Ihe City ol Everett Irom any and all claims lor damages, costs, <br />expenses, or causes et action that may arise because ot inslallalion <br />and maintenance of the improvement or olher ri�ht�obway use herelu <br />applied lor and lurther agrees to remove same upon no0ce Irom the <br />Ci1y and to replace public property damaged ihereby. <br />� � . �, _-z� � <br />Signature ot Applica �ale <br />WORK AUTNORI2ED BY THIS PERMI'i MUST BE STAFTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND TI�{EREAFTER IS TO <br />BE DILIGENTLY FURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TfIIS <br />PFOJECT OVER 50 DAYS DUR�:TION. <br />i <br />4 <br />�� <br />r, <br />