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Date�`L'J C) <br />App�ication For <br />PUBLIC WOR�(S PERMIT <br />Print or Type Only <br />Owner <br />Lp <br />Fu01¢1Vo�ASPepJ v"' ��O <br />cT- <br />omq oco�� � _ <br />Publ�t Wo�hs Fee <br />iotel Fce s <br />�esa RpPL Fec Paid $ <br />� ln <br />Balance Ouc S �-'� <br />Prolecl Address (if known) <br />ST. <br />Attach four (41 copies ol plans for proposed work - Draw to scale and note the lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Exisling and proposed utilitics <br />• Centerline ol street <br />• Indicate Nor�h <br />• Show any proposed c�rading changes <br />• Show measuremenls <br />PERMIT COND�TIONS <br />1. All calls for inspection shall be made 24 hrs. in advance � phone 259•8810. <br />2. All work shall be performed in acwrdance with this permit and current City ol Everett Desic�n and Construction <br />Standards and Specilica�ions. <br />3. Catl Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />f! SE'f' C��.e€cr�,o S,rF �F�,� Fo2 .a,�o.o,E-.� st-wi--.e <br />. <br />LUli1T�2 /9N,0 L�Ain/AGG' C�nl.vis cT.Dq/Cl'. <br />J� ST,Q,c�r �i<�F ic Ba ir�.� cl�9N �.- �9�[ i.�s <br />lor <br />�. �E �?IBLiG l.VOLYZ/v���.�cTO.e, � Cui O.C' Nc�TiFJ/ <br />7' %fi�E C'u2B� Gv/iE2 �' Si�id9c� ��E'� .c/E!✓ �9.c%O <br />�/.t/�9m,q��,0 ,gv�' ,dqmrPG.� To %NcM SNALG d� <br />/�EG%i/—'E� /j�'tsri'GAC� �f/ %/✓c <br />l <br />` <br />FINAL INSF't[:IIUN 1\ � <br />Approved as Constructed V <br />everett PUBUC W� iKS DEPARTMENT <br />� 3200 Ceda� Street <br />Everett. WA 98201 <br />Phone:259�8810 <br />� <br />Date <br />�/�i'�c �Cfil.�/T. <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undersigned ownedapplicant hereby agrees lo hold and save harm- <br />ir;s ihe City of EvereU from any and all claims tor damages, costs, <br />ei.�enses, or causes of action Riat may arise because ol installation <br />and maintenance of ihe improvernen� or o�her right-obway use hereto <br />applied lor and lurther agrees to remove same upon nolice Irom �he <br />City and to replace public property damaged ihereby. <br />�p,�p �� �--� <br />�� • !/rL,., o� v d �.� ��fl <br />Signature ol Applicant Daie <br />WOFK AUTHORIZ[D BY THIS PERMIT MUST BE STARTED VlITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT A1AY dE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON TH:S <br />PROJECT OVER 90 DAYS DURATION. <br />