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Date�/' q � i0 -_ . <br />'�/ <br />ApPlicaticn For <br />PUBLIC WORKS PERMIT <br />Print or Type Unly <br />�iC.C''�iC-�yi2� <br />t/i <br />Mailing Address <br />FuOLc WorFs Pe�md . y a 76 `� <br />Bl�g DeO�� • <br />Pebhc Wor4s fee <br />Total Fre 5 _ __ <br />Less Fn01. Fr,e PaN 5}�'J�.�S�'�� <br />�alanr.e Duc $ �x '� <br />Phone <br />b I,��� r�- t� <br />� � // � � /� <br />Applicant Mailing Address City Lp Phone <br />Describe Proposed Work <br />C .. -� 3 . <br />Prolect Address (if known� <br />� <br />_')v I 1 � � <br />fti <br />� <br />Altach four (4) copies of plans for proposed work - Draw to scale and no�e ihe following as applicable: <br />• Property Lin�s <br />• Outline and dimensions of all existing and <br />proposed slructures on ihe lot <br />• Exlsling and proposed utilities <br />3 <br />• Cenlerline ol street <br />• Intlicale Norih <br />• Show any p�oposed grading changes <br />• Show measurements <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 ol Everett Design and Construction <br />Standerds and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NIINIBER 1•800-424•5555. <br />�/ a '/ ��'�/,��//�� ,��/�i5',%/ o� �S �� nt� <br />" /�/ r'�'«o .P c�, u� _ oFi=��� . <br />v� ,sci ��9�`� �,�'� c'o�'�=C �S <br />,: <br />FINAL INSPECTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl, WA 9A201 <br />Phone:259-8870 <br />�� <br />Date <br />/O -/G � <br />Date <br />�5 lQC G�//'�L�� <br />r/ <br />W <br />� <br />� <br />� <br />O <br />�"' <br />�%i <br />O <br />a <br />ACKNOWLEDGENENT OF CONDITIONS <br />The un ersigned owner/applicant hereby agrees to hold and save harm- <br />ess-fhrC-ity of Everet� Irorn any and all claims for damages, cosls, <br />expenses, or causes ot action Ihat may arise because of installation <br />and maintenance of Q�e improvemenl or other righl-ol�way use herelo <br />applied lor and further agrees to remove same upon notice Irom the <br />City and to replacqpublic property damageSYther�by. <br />�/iJRK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />780 DAYS OF DATE PERMI7IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 9J DAYS DURATION. <br />