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Date % s s <br />Application For � <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />P�_-� � �.� � ►� <br />Owner <br />�oo� ��« <br />Mailinr, Address <br />�I <br />maumg Aaoress <br />L�.. C�t S ka <br />City Zip <br />�, �, <br />Ci:y Zip <br />Describe Proposed Work e°^ S'T �..- ��, ,s ,n o+ v, � h o..., <br />ProjectAddress(IfknowN .���-'32_- 5� t�sj; Sbi� <br />PUEIicWorksPermil/a ' ✓��' �� <br />eco.00ci.= �LJS/S�/ _ <br />PuDlic Works Fee <br />TotalFea S. <br />Less Appl Fee Paid S <br />BalancnDue $ ������ <br />f� � G� <br />Attach !our (4) copies of plars tor propcsed work �� Draw to scale and note the following as applicable: <br />� Property Lines • Centerline of street <br />• Outline and dimensions of all existing and • Ir.,iicate North <br />proposed structures on the lot • Show any proposeJ grading changes <br />• Existing and proposed utilities • �how measurements <br />p�G <br />�Y /' !dY 7 <br />Phone <br />o.- �s5 -�357 <br />i� <br />Phone <br />PERM!' CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in atlo�nc= • phone 259•881 $. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standa�ds and Speci(ications. <br />3. Call Location Underground Sorvice 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />/- C X r5%/iUCi Q,o-?/Uc�=L'rJd f/ CL�% /O f�'E .�'�/n<^ L�'F� .e�'/✓V <br />Jiv�«e c.<"� �v.Pd' � G-v�7�-,c' Tv .Fs'E �f'�:--'�a�f� PE.0 <br />CiT� S: an�/J,1,e� � Jv5 f" 3�%G . <br />S" /L�FctJ O/'ir� �✓��j''' �.t� LOCi1T��h� SfiE�Cc/iL� OJV �Lu% <br />/�LA/1/ $�/GG � 6'E' 1.t�ST,dlCEl' r'�.0 <'iTy �;' d n/v '�7 <br />� �n: <br />\, �_ � /� <br />� .• ���.,� r..a� � /� <br />APProve�� l , _:e <br />� 7 L 2 -�� <br />FINAL INSPECTION Date <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar St�eei <br />� Everett. WA 98201 <br />� _ J Phone: 259-8815 <br />7 G,c <br />W <br />� <br />� <br />�J <br />♦�� <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT O� CONDITIONS <br />The undersipned owneyapplicant hereby agrees to hold and save harr,:• <br />less the Cily ot Everett irom any and all claims lor damages, costs, <br />expenses, or causes of action that may arise becaus= of installation <br />and maintenance of tlie improvement or other right-of•way use hereto <br />applied for and furiher agrees tn remove same upon notice from the <br />City and tu replace public prop:-rp� damaged the�eby <br />Siynature ot Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST 8F STARTED !NITHIN <br />78U DAYS OF DATE PERMIT IS ISSUED AND THEREAF'fER IS TO <br />BE DILIGENT�Y PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCFLLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THI> <br />PROJECi OVER 90 DAYS DURAT!ON. <br />