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DateJ! P�-1 � <br />Applicatien For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� �� <br />Applicant <br />�� <br />na AAdress <br />ng Address <br />Descrl6c Proposed Work � L%�.� � -)� <br />Proiect Address 1il knawn) <br />c�iy <br />Ci�y <br />� <br />o„oec wo��s w•r i �� � T`����� <br />B�n� Der� • .��1�y�. <br />�,����,�,vo,�,«o � <br />toia� Fee <br />Less AnO� feo R�uf S �J�r <br />LaldncCDur .� /—l�� <br />Attach four (41 copies ol plans lor proposed work - Draw io scale and note Ihe following as apPliwble. <br />• Property Linr,s • Centerlme of streel <br />• Outline and dimensions ot all existing and • Indicate North <br />proposed siructures on ihe lot • Show dny proposed gratling changes <br />• Existing and pwposed Wilfties • Show measaremenls <br />Phone <br />PERMIT CONDITIONS <br />1. All calls fur inspection sliall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pertormed in accordance with this permit and current City ol Everett Design and Construdion <br />Standards and Specifications. <br />3. Call Location Underqround Service 48 hrs. before you dig. TOLL FREE NUMBER 1•600•424•5555. <br />A. (yJ �a����7�RZ=�z AND `-� � ��,1= l-l/�11L �AG 'i�'G�`.�`-� t-Rct�7l-%<iC- CF <br />j�(LGPL-7�t`s' I�.� t1J C xc EL� LNT Cc.�nJ l� � i IEi.V W iTtt �1U <br />f3��1�� — ANu �YtAE�� Sr1ALL. 8C- 2�('����ci� F34 'TNL- <br />r1PPu c_�, <br />�5. 2Ce;F pC'I�.�NS .5 ��A�� i3� 'Te,�iT �- If.rt-�� `i� � � a �l�= �J�. <br />�li�ec � 1����� 12— jt �9 <br />Approved lor Consiruction Dale <br />J _. <br />,�/����� � / — 9� <br />FINAL INSP TION Jate <br />Approved as Constructed <br />everetl PUBLIC WORKS DEPARTMENT <br />� 3200CedarSlreet <br />Everelt, WA 96201 <br />Phone:259�BB10 <br />W <br />H <br />� <br />N <br />� <br />Y/ <br />O <br />a <br />ACICNOWLE�GEMENT OF CONDITIONS <br />The undersi9ned owner/apPlicant heieby agrees to hold and save harm� <br />less the City ol Everett trom any and all claims lor damages. cosis, <br />expenses, or causes ot action that may arise because ol inslallation <br />and maintenance ol the improvement or other righbol-way use hereto <br />applied lor and turiher agrees to remove same upon notice irom ihe <br />Cily and to replace public property damaged ihereby. <br />� <br />i aturc ol Applicant � � � Date <br />y RK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PUFSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY ThiE CITY UPON �NY S10PPAGE OF NORK ON THIS <br />i�ROJECT OVER 90 DAYS UURATION. <br />