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x�� <br />CT� <br />I� '.V CC <br />9HxCH/� <br />H x �H <br />�C f) <br />H� <br />'i1 H A7 <br />VJ H <br />[<7 O � <br />H <br />OH <br />��g <br />� Y (�] <br />�H� <br />h <br />�yH <br />C❑] C7 y <br />trl � Cl1 <br />z �-3 cn <br />H O V� <br />���/�//� `( �3C� -Z� �} <br />Date_<c��aC—/ %� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />TO POS?I;dG?-/��'� <br />Maiiing <br />Mailing Address <br />Describe Propcsed Work f� �� <br />Proiect Addres lit icnown) __ � �� � 5� S <br />Puoimwa�MSPar ' . � I / <br />. <br />eiao. onm. , , f <br />Pubi¢ wmks Fee <br />Toiai Fce S — <br />Less ApO� Fee ParO S—�— <br />ealancc �ue S 1� <br />� <br />uu ���..��c <br />Atlach teur (4) copies el Pians lo� proposed wo�k � Drew to scale and note the lollowing as applicable: <br />• Properry i_ines <br />• Guliine and dimensie.^.s ot al: existing antl <br />pro, osed structures on the lot <br />• Exisiing anr' ��oposed utilitie5 <br />• Centerline of straet <br />• Indicale Norih <br />• Show any proposed grading changes <br />• Show measuremenis <br />THIS LIN <br />PERMIT CONDITIONS <br />1. All cells for inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All vwrk shall be pedormed in accordance viith ihis permit and current Ciry of Evr.rett Design and Construction <br />Standards and Specitirations. <br />3. Call Localio� Undern ound Service 48 hrs. 6etore you di9. TOLL FREE NUMBER 1•800-424•5555. <br />�c�.S�,l/ll`�:vZ z�zb�� <br />Approved br Construction Date <br />��l'��(�1- 3-/5'-5'3 <br />FINAL INSPECTION Date <br />AnProvr.d as Constructed <br />������� PUBLIC IVORKS O::PARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone'.259�8610 <br />ACKNOWIEDGEMENT L`F CONDITIONS <br />�w <br />_ / <br />O <br />a <br />The untlersigned owneUapplicant here6y agrees to hold and save harm� <br />less the City ol Everetl Irom eny anA aJ claims for damages, coots, <br />expenses, or causes ol actie� that may arise because uf inrtalla;ion <br />and maintenance ol Ihe improvement or olher ri�ht�ol-way �.. �-�ereto <br />applied lor and lurther agiees to remove same upon notice Ir. m the <br />City and to replace public pronerty dey�nac�ed�lhereby. <br />� <br />5�9nalure ol Applicani � ' Ua�e <br />WORK AUTHORIZED �Y THIS PERMIT MUST BE STARTED WITHIN <br />1Q0 DAYS OF DATE PERMIT IS ISSUED AND THERcAFTER IS TO <br />BE DILIGENTLY PURSUED TO C�)MPLETION. THIS PERMIT MAY BE <br />CANCELLED BY TH[ CITY UPON WY °'70PPAGE OF WORK ON THIS <br />PROJECT OVflR 90 DAYS DURATION. <br />