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Date � � "�-S <br />ppplicalion For <br />p�g�„�� W1�RKS P�RMlT <br />Print cr Type Only <br />f i�o�� 1�I-.��-r� ?���i'l <br />Uwner Mailing Addre..s <br />Describe Proposed Work <br />� <br />Ciry <br />-Q.� <br />Pu�liclYoiksPcrmita _— <br />Binp. Dnpl. r <br />PueLc vlorb Fso <br />To,d� F�a <br />�� <br />Lr.ssAppl.Fce �e � <br />OalTncn f�c <br />� <br />� <br />z�ti <br />Phone <br />{d <br />Project AdCress (if knoHn) <br />�.i �I,;'>> I�i��r' _:.�LQ.� ��-- _ <br />Attach four (4) copies of plans for proposeA v�ork - Draw lo sc�le and note tY�e lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures un the lot <br />• Existing and proposed utilities <br />• i:enterline ot street <br />• Indicale Norih <br />• Show an� proposed grading changes <br />• Sho�.v measuremenl, <br />PERMIT CONDITIONS <br />1. All calls tor insper.tion shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All w�rk shall ba Pertormea in accordanr,e with �his Fermit and currenl City ol Everett Design and Construclion <br />3�an.fards 2nd Sper,itications. <br />3. C•all Loc2tion Underground Service 48 hrs. before You di9. TOLL FREE NUMBER 1-800•424-5555. <br />'���[tL,�. Tb ��. �uL•�7C�p �H {'<!-L���� <br />�l�`F*•51k� i-1 C�- i�'_�``�-�'�L Pf,��"' �'� <br />L�'�=C o�l��'� i-ll c�t� • <br />� �`��� �/��. �� ��L:.,"�� <br />Approved tor Cons�ruction � Dale <br />✓ � <br /><� /: /c� <br />�J.%'� �R.�GG-- /D../l'—�1' _ � <br />�� Date <br />FINAL INSPECTION <br />ppproved as Constructed <br />everett PUBLIC WORKS D[PARTMENT � <br />� 3200 Cedar Street <br />Everett,'JJA 98201 —�'+�u <br />Phone: 259-8815 <br />-�'r,-(QU\«�� <br />lt <br />� <br />O <br />ACKNOWI-EDGEM[NT OF CONDITIONS <br />The undersigned owner/applicaM herebY agrees to hold ard save harm- <br />less the Ci�y of Evere,tt from any and all claims tor damages, costs, <br />^xpenses, or causes ol aclion that may arisr because af installation <br />and mainlenance of �he improvemen! or other righl-uf-way use hereto <br />applied lor and furfher a9rees to remove same upon notice from ihe <br />City and to repiace public property damaged lhereby. <br />� ��, 'Tl✓� �1 i � � � �K� �/'�.UJ <br />�` (,b�1.l.� �� -� Date <br />gnature ot nPP�icant <br />WORK AUTfiORIZED B� THIS PFRMIT MUST BE STARTED WITHIN <br />t� DAYS OF DA?E PERMIT IS ISSUEC AND THLREAFTER IS TO <br />�E DILIGENTLY PURSUED TO COMPLETION. T'rilS PERMIT MAY BE <br />CAtJCELLED BY THE CITY UPON ANY STOPPAG� OF WORK �N THIS <br />PROJ[CT OVER 90 DNYS DURATION. <br />z <br />0 <br />-i <br />... <br />c: <br />m <br />