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u <br />� <br />� Cys] � <br />d% xJ x <br />9 H fn <br />y � r�i <br />� H� <br />"�Q N'+,1 <br />VJ N <br />a <br />��d <br />OH�J <br />H L'�� O <br />�j] Y (i <br />7~S H � <br />��x <br />HH <br />gy <br />�d� <br />��� <br />z y cn <br />H O �n <br />Date�-1� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />����,� wo„s P9,� � <br />9�a9 Dnpt < <br />PutoM1c V:orYs Fee S <br />Total Fee <br />less Aoo� Fce Paw S <br />IBaiance Oue S <br />+�3 s�, tiid i��- Sc,J �'v L� Ik 9 <br />Adtlress City Zip F <br />��E �v C4.t,t��:� �� (,C� �� � 2'.�03 � <br />Addre� City Zip F <br />DeScribe Pro�oSed Work �`✓�115_✓�^�'�'1 v� � <br />Pwlec� Address (il known� <br />Aetach four �n� copies of plans lor proposed wore � Draw to scaic and note the follovnng as applicable: <br />• Property Lines • Cenie�line of s�reet <br />• Outline and Aimen;�ons oi all ezislmq and � Intlicaie North <br />proposetl siruc��res on tho lot • Sbow any proposed q:adinc� chan{�es <br />• Exis�ing and proposed utilities • Show measuremonts <br />PERMIT CONDITIONS <br />1. AII czlls for inspection �hall be made 24 hrs. in advance � phone 259•8810. <br />2. All work shall be performetl in accordance with Ihis permit and current City o� Everet� Design antl Consiruc�ion <br />Standards and Specifications. <br />3. Call Location Unde�grountl Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />/ lJ0-(-'�G� „�rUcrr/�Y ���r�c-� .�,� ���t/tt.d� <br />� <br />Approved for Consiruction <br />D��e <br />FINAL INSPECTION Date <br />Approvea 35 Consiructed <br />eve�etl PUBLIC WORKS DEPARTM[NT <br />� 3200 Cedar Streel <br />Everett, WP. 98'.01 <br />Phone,259�8�10 <br />���,����., <br />z -�� -� � <br />W <br />H <br />�w <br />_ / <br />Z <br />O <br />ACKNOWLGDGEMENT OF CONDITIONS <br />7'he undersi9iied w�ner/applicanl hereby agrees to holU and save hnrm- <br />less Ihe City cl Everelt from any and all claims for dama9es, cosis. <br />e<penses. or causes ol ac,�ion lhai may arise because ol installalion <br />❑nA inaintenanr.e o� Ihe imUwvement oi o�her nr�ht-ol-waY use herelo <br />appl�ed �or and fur�h�;r ayrees to remove same upon nohce Irom �he <br />CitY ;���d Io replace public ?roperty dama9ed IherebY. <br />Si9n:dure ol AUPlics.�� Date <br />WORK AUiHGRIZED BY 1'HIS P[RMR MUST BE STl1RTED WITHIN <br />180 DAYS OF DAT[ PERA4IT IS ISSUED ANU THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED BY THE CITY UPON ANY STOPP�GE OF VJORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />