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Date�O <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />i <br />Pu01¢ lVaFs Permi� • yCJ <br />_ 3% <br />Biclg Depl • <br />PuOrvc WprFa Fi <br />iotalvee S <br />�ossnow Feevaro S <br />O <br />Baiance Due $ 20�� <br />Applicant Mailin� Address <br />/� � J % J <br />Describc Proposed Work 7 /1 '�9" [�+C C ��� � l T <br />Prolect Address (if known) <br />Atlach four (4) copies ol plans lo� proposed work � Draw to scale and note the following as applicable: <br />• Property Lmes <br />• Outline and dimensions of all exisling and <br />proposed structures on the lot <br />• Ezisting and proposed utilities <br />• Centerline of street <br />• Indicate Norlh <br />• Show any proposed gradin� changes <br />• Sl:ow rneasurements <br />PERMIT CONDITIONS <br />1. All calls Ier inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pertormed in accordance viilh ihis permit and current City of F�erett Design antl Consiruction <br />Standards and Specilications. <br />3. Call Location Underground Sen�ice 48 hrs. hefore you dig. TOLL FREE NUMBER 1•S00•424•5555. <br />� /!-CC�`''ti� Ci��.1t..c� J�IIt.C'�� �!. �a0 S`hctL�:/ <br />(/ �/ � �r O <br />�2.J 7� 7'2 ciw� <br />, <br />e� — �J��� , <br />T�.T.w L�.�c-�ii../ ,u(.cJ' filGlCif� /(� /L� '. <br />'� `3 <br />'%lli���c�-�-� /�9�9n <br />�PProved lor Con irrction �Ta�� <br />��?�/l� -- � z _�� <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />EverelL WA 9820t <br />Phone:259�8810 <br />W <br />� <br />� <br />I"' <br />V♦ <br />O <br />a <br />02/OS/90 �:04FM OOOAH9816 #11� <br />/ <br />ACKNOWLED�(I���F CONDITIONS <br />The undersic�ned owner/appli�i�LQBreby:#,�a� hold and save harm� <br />tess the Ci�y ol Everett tror��and al�g(�jj� lor dama9es. costs. <br />eapenses, or causes of action Ihat may arise because of installation <br />anA maintenance ol Ihe improvement or other right-obway use herelo <br />applied tor and Iwlher agrees lo remove same upon notice irom Ihe <br />Clty and to replace pubhc property damaged Ihereby. <br />WORK �UTHORI7ED BY TfiIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERIAIT IS iSSUED AND ?kiEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. 1HIS PERMIT A1AV BE <br />CANC[LLED BY THE CITY UPON AN1' STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />