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Date�'`E' 8� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� <br />Owner <br />2 <br />y <br />City <br />�. S <br />Describe Proposed Work �V � L. 17 �l �V ���-SI fl G-jV C f_, <br />Project AAdress (il known) 7 2�� — <br />PuOL< Worts Parmit • f�'6 - -3�5� <br />eieo� Dao�- • <br />���orc wo�«� raa <br />toix� Pea S _ <br />L.+se noo�. Fee Peia S_ <br />Bal.nceDua S_ Z�00 <br />Attach four (4) copies o� plans for proposetl work - D•aw �o scale and note the fcdlowing as applicable� <br />• Property Lines • Cenferline ol strael <br />• Outline end dimensions of all existing and • indicale North <br />proposed structures on the lot • Show any propo.etl grading :hanyes <br />• Existing and proposed utilities • Show measu�ements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls lor inspection shell be matle 24 hra in advance • phune 259-881 5. <br />2. All work shall be Derformed in accordance with this permit entl current City ol Everetl Des�o^. and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 4B hrs. before you diy. TOLL FREE NUMBER 1•F100•424•5555. <br />t,.�� j�R�VE� Sldu�IL� gC-C rr1 Uf�wY�i^tiJ C-�RADE <br />(�� Eo�L o�- �-o-�.J r��5' F-�� or izo�, <br />� 12�sPi�� R-CQ�n �02 �Z�r� c�r- l�czi✓c-� <br />' lIJ GIT`( R-O-�nl .�-/�-� �fL �tJSFx-CiLn�1 2�-%1.v1. <br />(o . �1`{ �nnP„'lrJ ic-�lC-+�I-� S� ��c-� i+�1 �- �� �l U�- a�'- t,�� <br />P�(�J�P�._ PsrJ�li�o/�-)%�L �T�£- �lJSPEc7-�c�1 �j�ri <br />Ti-1� P�P�e� �- w�tz,ics oFr � c� , 1=e .��cxKr-��c-s -e.T�� <br />� <br />(,U Or '- �—' c' s o /i � <br />_ rroc j �C�r..r'<. <br />`�Lu�.�.�i o�- i //�B ° <br />Approved f on ruction Date <br />. � �/���/��/� /-'�/9�� <br />FIN INSPECTION ` � , � Date <br />Approved as ConstructeA <br />eveiett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett, WA 98207 <br />Phone:259�8815 <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOVt�LEDGEMENT OF CONDITIONS <br />The unde sigm �d owner/applicant he�eby agrees to hold antl save harm• <br />less the City of Everetl Irom any and all claims lor damages, costs, <br />ezpense5, or r.auses ol action that may arise because of installation <br />and main;enance oi Ihe improvement or other right•of�way use hereto <br />applied tor and further a�rees to remove same upon nolice from the <br />City and to rep�ace public properiy damaged thereby. <br />i <br />,< <br />� ��___� <br />Signature oi Ap{: cant �` Date <br />WORK AUTH IZED BY THIS PERM T 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 />CANCELLED BY THE CITY UPnN ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DP.YS DURATION. <br />