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Date �" ` I <br />Application For <br />PUBLIC WORKS PERMfY <br />Print or Type Only <br />AppGcant <br />Mailing <br />Describe Proposed Work �L�'�� <br />c�ry <br />Ciry Lp <br />ProjectAddress�if known) J��/J `'' �s��t- S��'�" � <br />Attach four �41 copies of Flans for proposed work � D�aw to scale and note ;he felioviing as appiicable: <br />• Property Lines <br />• Outline and dimensions of all exisliny and <br />proposed slructures on the lot <br />• Existing and proposed utilitie; <br />✓ <br />�/�/ � <br />Puni�c Wods Per �'-'{` �''"'�'J^ <br />Btrf9. Depl. . ._� ���_ <br />PubLc Warks Fee <br />TalalFce � _ --�- <br />Less Anpi Fer Pm0 $ �.h— <br />Bal�nreDuu $ �/�' � <br />• Centerlina of street <br />• Indic2te Norih <br />• Sliow ::ny proposed grading chan9es <br />2 Sno�n measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current City o( Everett Design and Constructiun <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� �C<<,v:i �'r-�a--n��v%'ti.;,.: S�Z.�I' /�C <br />�' l�d��%� � <br />��1�f% 1��2 <br />� �,; �!%Y� C�tc_� Cl. �'q <br />i' <br />C...zr f,JR(:f/' �• �s/rE:-�C�-/� , <br />J� �C�`7t7��-Cf� .%��LL-. <br /><< ��'ti' �J:2��%y <br />l�-:�� «�, ��•,�Y. <br />C�vic.G�, �i.�[>�Y _X-i,'�`..%� <br />�-Gc LcL ���� ���I� <br />4 <br />Ct.� ���cl�EcE �<,t`z�o� �,�:��zcy`z�� _ <br />; � �ot� /�ZGC�v_/�L1<y' J-Cc" �'" C'�'Jcz.c .v <br />�_,.,�;. ,�� ���; r�j�:� , <br />_/% / <br />�G/1:=�C-S�-,.� J .:� ;�% <br />Approeed for Consiructio J �f Date <br />�1� " l /� _"- /i -� ��' <br />FINAL 1�SPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett WA 98201 <br />Phone:259-8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />I"' <br />� <br />0 <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everetl from any and all claims for tlamages, costs. <br />expenses, or caus,es of action ihat may arise 6ecause of installation <br />and maintenance of the improvemenl or other right�ohway use hereto <br />applied tor and funhr.r agrees to remove same upon notice from the <br />City and to replace public property damaged thereby. <br />Signa ure ol Applican� r � J at �� <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED VJITlllil <br />78J DAYS OF DATE PERMIT IS ISSUEU AND� THEREAFTER IS TO <br />BE DILIGENTLY PIIR£iUED TO COMPIE'fION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK JN THIS <br />PROJECT OVER 90 DAYS DURATION. <br />