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� y <br />Q�H <br />� H C/� <br />H�� <br />�pH� <br />'+tl H � <br />Hy <br />x <br />o�d�y <br />HC��JO <br />QY (] <br />t"y� <br />HH <br />g`� <br />H <br />Ot7fA <br />�O� <br />' <br />f <br />A <br />Date1L�7- ��— <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Typa Only <br />Describe Prouosed Work <br />� <br />Project AAdress (�' known) <br />Mailing <br />Address <br />City <br />City <br />� IPublmlYo�MSPur�mJi/�+?� <br />BlaeDeots .JXJh7 <br />Pu�im WorMs Gee <br />To�m F�� $ — <br />Less nooi. Fee Pa�a S__ <br />Balancc Ouc � _ <br />Attach lour (4) copies o� plans lor proposetl work - Draw to scale and nole the following as applicable: <br />• Property Lines • Cente�line ol sireel <br />• Oulline and dimensions ol all er.isting and • Indicate North <br />proposed structures ori the lot • Show any proPosed grading changes <br />• Existing and p�oposea utilities • Show mezsurements <br />�� <br />Approcedfor <br />�.J ' <br />Phone <br />rnone <br />PERMIT CONDI i IONS <br />t. All calls for Inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be perform?d in accordance with this permit and current Ciry of Everetl Design and Construction <br />Standards and Specifications. <br />3. Cail �ocation Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />� itiiiln�. � NSPECTION <br />KIRK BROOKS <br />uf4;�' �� Y 5z <br />Date <br />FINAL INSPECTION Date <br />Approved as ConstrucYed <br />PUBLIC WORKS DEPARTMFNT <br />3200 Cedar Slreet <br />Everett, V!A 98201 <br />Phone:259�8810 <br />HUF�j.�� WfykKS kE$jy�I� <br />NOT REOUIRED <br />BY-__Z��' %� <br />�Ai� /_ l� l2 � <br />W <br />H <br />�w <br />_ / <br />� <br />O <br />♦�A <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The untlersigned owner/applicanl herzby agrees to hold and save harm- <br />less the Cdy ot Everett iwm any and all claim=_ for damages, costs, <br />eapenses. or causes ol action that R�ay arise because of installation <br />antl maintenance of the improvement or olher right-of-way use hereto <br />applietl for and furNer ac�rees lo remove same upon notice irom the <br />Ciry and to replace public proFerty damaged ihereby. <br />Slgnature ol Applicant Date � <br />WORK AUTIIORIZED BY THIS PERMIT MUST BE STARTED WITHIN � <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO i <br />BE DILIGENTLY P:IRSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS � <br />PROJECT OVER 90 DAYS DURATIOP:. <br />