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Date�c��� <br />Apulicalion Fo� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />yN <br />Mailing <br />Address <br />Describe Proposed Work <br />ProlectAddresslifknownl /a'v7�' <br />Publ¢ wo�ha Vermi` �e ��7��� <br />ein� oca� • - r��.L� --. <br />runncwo��sfee g <br />.e,�� ��� _ <br />tessnnni vneVaia $ — <br />Balaace�oc � ���'O <br />c��v <br />�dl/la�f��✓p�P17� �i.��cQ .3S3GSaJ <br />City ZiP Phone <br />Atlach lour (A) copies ol plans lor Proposed work � Draw to scale antl nole ihe lollowing as app�icable: <br />• Property Lines <br />• Outline and dimensions ot all o.isting anA <br />proposetl strucWres o� the lot <br />• Existmg and proposed utiGties <br />• G:n�erline ol street <br />• Indicate. Norih <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All cells for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pedormed in accordance with Ihis permil and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />y e�n.�'-�(.!' ��� ��� l.�,.���,.� Cat 9�/O <br />C2,� C%thec�ec0 � X�rJ �Cc� �.t� .�fe Lc%rt.?i r�z.a,4.ci`-r�v. <br />f� t��-��j� � /J—` <br />'�' � '7�"�� 2'��/0'�': � �� <br />Approved�b� Consiruction Date <br />/'- �.4 //-`�.�.�// i/�;/��� <br />FINALTNSPE(�TfON �� Date <br />Approved as Constructed <br />c�verrtt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Streel <br />Everelt, WA 98201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />7he undersigned owneUapplicanl hereby agrees to hold and save harm� <br />less the CAy of Everett irom any and all claims for damages, custs, <br />eapenses, or causes of aclion that may arise because ot ins�allation <br />and maintenance of Ihe improvement or olher righl-ol-way use hereto <br />applied for and furlher agrees to remove same upon notice trom the <br />City and to replace public properry damaped ihereby. <br />/=�r„�_ li /�! -, � •-1- -� ; <br />Signature ol App/licLa6�' Dale <br />WORK AUTHOP1ZtD BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELIED BY THE CITY UPCN ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVE`i 90 DAYS DURATION. <br />