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es : �€. <br />e �, <br />�". h.:.:�. <br />.'.rber-+t�t%�'S�sF�t'-�yn'+ <br />Date �� � <br />Application For <br />P�1�iLIC WO�KS F�ERMfT <br />Print or Type Only <br />Mailing AtlCress <br />1/ <br />PuO�rc Works Porml� � �� � � <br />��-einy. oeoc . <br />P�blic Works Fee <br />Ta�alFee 5 — <br />Less FpPL FC2 PaiO 5_. � <br />�alanceDue $ ��'G�O <br />Phone <br />G�1rY�- ��S 3 �� <br />Applicanl Mailing Address CItY 2iP Phone <br />Dascribe Proposed Work _ �^��C"'--� `� <br />P:�oject Address (il known) <br />/S � � �' - ��� �,% <br />Atlach lour (4) copies ol Plans for proposed work - Draw to scale and note the tollowirn� as applicable: <br />• Property Lines <br />i OuUine and dimensions of all existing and <br />proposed siructures on ihe lot <br />• Ezistinu and proposed utilities <br />• Centerline of sireet <br />• Indica�e North <br />• Show any proposed greding changes <br />• Show measuremenis <br />PERP,IITCONDITIONS <br />t. All calis tor inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be pedormed in accordar •�+ith this permit and current Ciry of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you diy. TOLL FREE NUMBER 1-800•424-5555. <br />� .�Cf:GLi.i[}.C�' iL�LTYl�� .�(�C7'l.l� `�-t%� ��'Zlf�'A 11�, ./Il. � C)_��C.�r"' <br />e/ U • �j <br />c�l!'_,f-OZ�' �-GC,tL:GC-Lry �1T.C.f .CO �Coi1L<!/✓� OZ ✓C���7a'./ <br />U �/ <br />i <br />((.r�{:.cRm.-7� J+��[�2i4�jc>Z[.�ili.� •2 �-�i�G2.,rna�A-L�C.' C'L�..�c-�)a� Sf' <br />�9 � <br />�� ��' �'� �` <br />� �c.Ga.� �.if[dc�� �1G /1C. ��cf�</ ,,�-0�' `�� �;p �L� �G2�ni"2.:Y <br />�y /� L J <br />J-�4�.�d/ ,�Q.:�i:'�'%'J1rc<:���i,[.tu-i�'.✓ ��!!'��✓ QCC l.Jc'f. ', <br />iJ <br />v' <br />G%'ji <br />� 2 /E -�% <br />��ppro �d f onsiruct' % Date <br />/ _.,�Q�/j�. �-.?3-� <br />FINAL INSPECTIOIJ Date <br />Approved as Constructed <br />everetl PUBLIC WORKS �EPARTMENT <br />� 3200 Cedar Street <br />Everelt. WA 98201 <br />Phone: 259�8870 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />LJ <br />The undersigned owner/applican� hereby agrees to hold and save harm� <br />less �he City of Evere�� irom any and all claims for damages, costs. <br />ezpenses. or causes of action ihat may arise because ol installation <br />and maintenance ot lhe improvement or olhar right-of�way use hereto <br />applied for and furiher agrees lo remove same upon notice irom the <br />City and [o replace pubiic property damaged lhereby. <br />i ! <br />� �J � .� <br />�� � / / _.�l�rli �� ' <br />Signa�ure�ol Applicant �bate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREArTER IS TO <br />BE DILIGENTLY PURSUEn TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON TFiIS <br />PFOJECT OVFF 90 DAYS DURATION. <br />