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Date�� <br />Applicatlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Address <br />Zip <br />p�piic Woika Pcrmit • � �� <br />Biav. Deo�. • gy �.3 iT� <br />Pu���mWoikaFea s ?���d� <br />Tolcl Fae <br />Less APG� fee PaiO S <br />Bala�ceDua S �' � O <br />Describe Proposed Worh <br />5� a .� ��,,,._� < <br />Prolecl Address (if known) - — <br />A�tach lour (4) copies of plans lor proposed +vork - Draw lo scale and nole the follo xin� as appllcable• <br />• Property Lines <br />• Outline and dimensions ot all existing and <br />proposed st�uctures on the lot <br />• Existing and proposed utilities <br />• Cenlei�ine o1 slreet <br />• Indic<Ao Norlh <br />• Shov: any proposed grading chan3es <br />• Show me^.5uremenl5 <br />PERMIT CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance - phone 259-881 5. <br />2. All work shall be perform�d in accordance with this permit and current City of Everett Uec�,;� -.nd Construction <br />Stendards and Specitications. <br />3. Call Location Underground Service 48 hrs. bebre you dig. TOLL FREF. NUMBER 'I -ii00•4t4-5555. <br />� Yt�� �of' � ex�...Y �fw,..a,t G.eros� d-«< Q��'�...�i-- <br />�ai.�aSc. I 1 � ` 1 <br />I .. L �. .o � n t N'I N S� �r -� d V'a� � r. f� �...� 'k-�^'� <br />y�0� S IG�C <br />�. �j. R ��io�.-. <br />�� w4�i� <br />�,P►o..�. <br />OY .�,Q �o� �U �� E'-Xl9�lYlj <br />�� � G� Z G � O �Y— <br />5.�5�(r� l�•^� � <br />�� L I '. -2 S-� S �p.... 1.�: <br />,s� 5�...�I- I � vi'e S � K�-o •l- i <br />3-/F <br />pproved for Constr ction . , Date <br />�� � C ��� <br />''� `//��' � �l �C-� "+ar ,' ci�/ <br />--1 T� Date <br />FINALINSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 9020t <br />Phone: 259-BB15 <br />ACKN0�1'LEDGEME'JT OF CONC ITIONS <br />� <br />O <br />�w <br />_ I <br />O <br />a <br />liie undersigned owner/app�icant he�eb)' agrees'o hold and sa�'e harm� <br />�ess the City ol Everetl (rom any and all claims lor damages, cosls, <br />e.penses, or causes ol aclion that may arise because of inst:.11ation <br />and maint ance of the improvemenl or other right�o4way use herelo <br />applied I�and turlher agrees to remove same upon notice Irom the <br />City aQd replace publiy property ��9ed thereby. <br />Signature ql ApG�icant ' % r'�- <br />WORK AU'iIiORIZED ,3Y TF11S PERIA MUST BE STAFTE� WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND TFIEFEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAuE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />� <br />� <br />H � <br />a . <br />H•: <br />�� <br />� <br />6� <br />F- <br />�; <br />�: <br />g� <br />� <br />H <br />�� <br />C; <br />C <br />�' <br />�3' <br />i7 <br />z, <br />