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� <br />r <br />r <br />Date�YL�Lc7.3 <br />� / � <br />ApF�icatlon For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailing Atldress <br />Describe Proposed Work <br />Pro�ect Address �il known) <br />Zip <br />Zip <br />PuLl2 \Yorha Permil ♦ �� � � I <br />BIEp pPpt • / � <br />vuoim wo�ke vae <br />toteiiex S �• �UQ <br />4es�oa�.:oeraia S <br />BaiancaDue $ .��. � � <br />Altach tour (4) copies ol plans tor proposed work - Draw lo scale anA note Ihe lollowing as applicable: <br />• Property Lines • CeNedine o� street <br />• Oulline and tlimensions M all enisting antl • Intlicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing anG p�oposed utilities • Show measurements <br />PERMITCONDITIONS <br />1. All calls br inspection shall be made 24 hrs. in advance - phone 259•8815. <br />2. All woik shall be perlormetl in accordance wrth ihis permi� and currenl City ol Everetl Design and Cons�mc�ion <br />Standards and Specifications <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� <br />��IJfVVCi..� GL�C�9�i a�o! I��P�..J �GI,fG. t' Lw1A5T ✓E:_ <br />�oM a 11 P y � o+ .� o,.� ;� �, � s-�, <br />� <br />A�pi6�ed lor Construction '� Dal <br />L �� <br />i / <br />/!�)/� ���! �C�-- /_�C%—�f' <br />� FINAL INSPECTION Dat <br />Approved as Conslructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett WA 98201 <br />Phone:259�6815 <br />- Y/ <br />W <br />H <br />N <br />�� <br />� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicanl hereby agrees to hold and save harm- <br />less the City ol Everett trom any and all claims for damages, costs, <br />expenses, or causes ol action ihat may arise because of installetion <br />antl mainlenance of the improvement or other right�of-way use hereto <br />applied lor and further agrees to remove same upon notice Irom the <br />City and to replace public property damaged thereby. <br />�CL���� z � <�.� <br />Signature of Applicant Date <br />WORK AUTHORIZED BY TNIS 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 />CANC[LLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />� <br />� <br />�� <br />� <br />J <br />� J <br />