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� `� Date.L�'� ��C� <br />B-�-Z??:-1}' <br />Application For <br />PUBLIC WORKS PERMIT <br />F,int or Type Only <br />/'1 N <br />�� <br />ng F <br />Mailing A ddress <br />v � <br />Describe Pr000sed Work / iU .�� <br />Prolect Address Iif known� 5-7 3°� <br />Attach four (4) copies ot plans lor proposed work • Draw lo scale a <br />� Property Lines <br />• Outline and dimensions of all existing and <br />proposetl struclures on the lot <br />• Existing and proposed utilities <br />DO NOT WRITE <br />a„m¢wo�xerx��U"u�. ��� <br />eiao oeo�- � J.� <br />i <br />PuOI¢ Wmb Fee <br />iatal Fec S <br />LeSs AOpI Fca P��J S <br />Balan<e0ue $ �� <br />� <br />��i i�/ r''/:- �l�'� I�..�l�S-.�-1�C�' <br />CitY LP Phnna <br />1 <br />��p,�P�, <br />_�— _. <br />�I s,� �' ,[�l�S -���,-i-- <br />= . -�--� �c� �« � <br />- . <br />` - ne^'�l S, <br />` �I� <br />;,_-�_ � IT'S YOUR PROBLEM NOW <br />.-, r.rn c nn u+e r.r�. er�. Fc <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in aAvence � phone 259•8810. <br />2. All work shall be pertormed in accordance with this permit and current City ol Everett D�acign and Construction <br />Standards and Specifications <br />3. Cell Location Underground Service 48 hrs. belore you tlig. TOLL FREE NUMBER 1-800-424•5555. <br />9• l�ppL�cn,.r N�AY t+�a�c � �Ms-nk�. P�µ� �-=-02 ��� <br />� <br />� F SO , I NSTI1Ll� /� 3� p�AM�=-tL'-TZ. NIQN EfcL�= C�N P2lVFRl� <br />{�QCj�EiZ�-�•� � C� VISCr1dV�'i7� j t�E '(�'ES$Ui�E I.tNE If�fi� ^ ible� <br />L-tZAvIT`( YICF�� A-c.�rtcs,;� � 1T'-f ftn4.1 T� ���.1- <br />e.l� �L /a i N . <br />'�n«L I��C� ' 2�5//9C' <br />Approved i8r Construction � ; pate <br />FINAL INSPECTION <br />Approved as Consiructed <br />everett PUBLIC WORKS DEPAFTMENT <br />� 3200 Cedar Sireot <br />Everet4 WA 98201 <br />Phone: 259�8810 <br />Date <br />� <br />W <br />�"' <br />� <br />� <br />� <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersi9ned ownedapplicant hereby agrees to hold and save harm� <br />less the Ctly oi Everett Irom any and all claims lor damages, costs. <br />expenses. or causes ol action Ihat may arise because ol inslallation <br />and mair,:enance oi Ihe improvement or other right�ol�way use hereto <br />applied - nd further agrees to remove same upon notice from Ihe <br />City d to eplace public property damaged Ihereby. <br />��< < y <br />alure ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT M�ST BE STARTED WITHIN <br />180 DAY� OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CAiJCELLED BY THE GITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS GURATION. <br />