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Date�F 5 <br />Application For <br />�IJBLIC WC1RiCS PERMIZ <br />Print or Type Only <br />qpplicant <br />Mailing <br />Mailing <br />City <br />Describe Proposed Work l�)/��� �.S/ av/=�—'�aET� �iQ/V�L��y <br />I Pul�LcvJoiksPermita C7J ��C% _ <br />Iei;�o. o�oi.. S � <br />Pv�licWorFSFea $ <br />Totul Fee <br />Less AppL Feo PeiO S ^ <br />eamncnouc § -'`'inD <br />%� 04 <br />.� ���� � �3� f �/yS� <br />Zip Phone <br />Project Address (i� known) _. ����� ^ 7�h l,� � G� <br />Atlach four ;4; copies ot plans for proposed work - Draw to scale and nole lhe following as applicabi��. <br />�� Property lines <br />�i Ou!line and dimensions of all exislinc� and <br />prcposed strur.tures on the lot <br />� Existing and proposed ulililies <br />O Centerline of street <br />• Indicate North <br />a Show any proposed grading changes <br />• Shov measurements <br />LiN <br />Phone <br />"ER>Afi CONDITIONS <br />7. A!I calls fur inspection shall be made 24 hrs. in advance � phone 259•8815. <br />2. All work shall �e performed in accordanCe with this permit and current City oi Everell Uesign and Constr <br />Standards and Specifications. <br />3. Call Location U�derground Service 48 hrs. before you dig. TOLL FREE NUMBER �•800•424-Ei555. <br />i <br />` �j/l ?/.'.' �li'C3'�/"'--✓ y /C' t1� <br />Approved for Constr ction Oate <br />�� 2 ti G -Z��'.� <br />FINAL INSPEC710N � Date <br />Approved as Constructed <br />eve�ett PUBLIC �^IORKS DEPARTMENT <br />� 3200 Cedar SUeet <br />Everetl, WA 98201 <br />Phone:259�80�5 <br />�CKNOWLEDGEMENT OF CONDITIONS <br />� 1' <br />�: <br />The undersi�ned owner/applicaN hereby agrees to hold and save harm- <br />less the Cily ��I Everelt fron any and all claims for damages, cosis, <br />expenses, or causes ot aciion �hat may arise because ol inatallalion <br />and maintenance ot �he improvement or other righPot-way use hereto <br />applied for and furi:�er agrees to remove s�me upon notice from the <br />City �ilii_to replace �ublic�property damaged thereby. <br />� �f �z 8�s <br />Si9n �re of Applicant � <br />W K AUTHORIZED BY THIS PERMIT MUST BE STAR"fED WITHIN <br />0 DAYS OF DATE PERMIT IS ISSUED ANO ?HEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COh1PLETION. THIS PERMIT MAY 8E <br />CANCFILEU [3Y THE CITY UPON A�V STO?PAGE OF WORK ON THIS <br />PROJECT OVER 90 D.AYS DURATION. <br />z <br />C <br />� <br />C� <br />m <br />�. .. <br />—� TI <br />.-. _'i <br />N= <br />0 <br />m <br />co <br />mo <br />�c <br />o� <br />m <br />2 —I <br />m <br />o � <br />c <br />r = <br />.. .-� <br />-i (/� <br />� <br />'�l <br />O A <br />-n a <br />� <br />-i f�t <br />x <br />m� <br />� <br />or <br />c-� m <br />c v� <br />m� <br />z �% <br />.�rn <br />n <br />� <br />-a <br />v <br />"c <br />� <br />m <br />