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Date S/io <br />.. . . . -?� �� ._.%S ��^i:. .. .� �T�'.'."t`$�,J.*'' <br />� <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />�•/i.: r ui� lv'i� i z- <br />Mai4ing <br />0 <br />�S <br />City Z�P <br />PUCIit Wo�ks Perm�: + <br />Biaq oeoi. • �' � � a �--�— �3 � % - <br />Publ¢ Wo�ks fee <br />Totrl Fee $ — <br />less Appl Fee Paia s— <br />Baiance D�e S _ <br />f�-77 <br />,i /.�l%,. ;7� -<'6 � S i� <// 77 �� <br />f i <br />'�� �7C � � .. %� c • Phone <br />l, s. ��,i .��l.s .n.1 i�..11 Z '' . , .. I`y � Z.� i <br />qpplicant Mailing Address l . <br />Describe Proposed Work <br />Prole�t Address (if known) <br />^ � . ) �: :A ! ' <br />�0,3 - 7�' Av� S.E <br />�..�*�- - <br />Attach four (4) copies ot plans for pror,osed work - Draw to scale and note � Ce°�ieWine of stPeei; able: <br />� Property Lines • Indiwte North <br />• Outline and dimensions ot all existing and � ghow any proposed grading changes <br />proposed structures on the lot � Show measurements <br />• Exisling and pro�osed utililies <br />PERMIT CONDI'�IONS <br />1. All calls tor inspection shall be made 24 hrs. in advance - phone 259-SSl O. <br />2. AIf work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specificalions. <br />3. Cali Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800�424•5555. <br />�C��r �� ..��.,_<;1 <br />C(%a'!�✓=��-U%,��r �1!��7� �� <br />i�_ � ,G:J �`'�.� G ' �' <br />�u..: �P/'� E�J� v`�'"�'i / � <br />� .i ,r� <br />/� <br />3'� % <br />Approved for Construction <br />Date <br />FINAL INSPECT�ON Date <br />Approved as Constructed <br />I everett PUBLIG WORKS DEPARTMcNT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259-8870 <br />—.___ .__. _.__ <br />� <br />� <br />O <br />a <br />ACKNOWLEDGE�AFNT OF CONDITIONS i <br />The undersigned owner/applicaot hereby agrees to hold and save harm� , <br />less the Ciry ot Everett irom a�ry and all claims for damages. costs I <br />expenses, or causes ol action thal maY arise because ot installalion <br />and maintenance ol lhe improvement or other iight-ol-way use herelo ,I <br />applied lor and further agrees to remove same upon notice irom the <br />City and to replace public property dama9ed thEreby. , <br />Date � <br />Signature ot Applicant i, <br />80RDAYS 6FRDATE PERMIT SESSUED AND THEREA TER ISHTO �� <br />BE DILIGENI'LY PURSUED TO GOMPLETION. THIS PERMIT MAV BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO.IECT OVER 90 DAYS DURATION. <br />� <br />