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Dat�� <br />F �8 -aa -s <br />Application For <br />PUBLlC WOR6(S PERNi�T <br />Frint or Type Only <br />Publ�c Works PoyPll •/ ���' � � <br />Oltlg. Oept s �Cl��� COLw l iY <br />i----v <br />Publlc Works Feo <br />To�ai Feo ff <br />Less qpo�. Fee Paid $ _ <br />�� 00 <br />Pala�ce0ue $ <br />Describe Proposed Work <br />Project Address (if known) 5'ai9 - 9�`' ��c. ..$_ L= <br />s?a: /rv'. '°�_S <br />Attach four (4) copies of plans for proposed work - Draw to scale and nole the fr�lowing 2s applicable: <br />• Properly Lines • Centerline of streel <br />• Outline and dimensiors of all existing and • Indicate North <br />pruposed structures on the lot • Show any proposed 9rading changes <br />• Existing and pruposed utilities • Show measurements <br />UU NUI wHllt dtLUW THIS LINE <br />r'ERMIT COIJDITIONS <br />1. All calls for i�spec�ion shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Stantlards and Specitications. <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUI1fiBER 1•800•424-5555. <br />5� � i.oEtJAC.0 ��� o^ �C .STi_ cEi /S i'✓E�✓ �' L-�.v 6:Po.CE'.�.�� ,�.V,!/ <br />Sif�E<c/9c.0 n.e i/�rd ,�f.�rnFJGE.0 r��i.ni.vG- C�ius„��vcT�o�t.' Sfi9� c <br />,��. .�� ;��fJcEv . <br />.�. �ii✓ �ri'�l7.y%i =F T..�c L.��T St��c-c. ..4r ,r�c>y; Sry f%S <br />/Vll. 7U J�;�1'r"7CT %N= �JTci�a',N,:i- L�"�.f' �c<.7</ i•'Pi.d�<�9i�: ��1�CJ�. <br />�/A �� / /o^LO c36 <br />G'�, %�Nc)i'l-Zz— i <br />ion Date <br />� � .,u. ,�_ /dI 3186 <br />FINAL IWSYEGTION <br />Approved as Constructed <br />everett PUBLIC WORKS DEPAR7t�tEN�� <br />� 3200 Cedar Sireet <br />Everetl, WA 98201 <br />Phone:259-8815 <br />Date <br />W <br />� <br />� <br />� <br />�• <br />♦ <br />ACKNOWIEDGEMENT OF CONDITIONS <br />The undersigned nwner/r oplicant hereby agrees to hold and save harm- <br />less the Ciry of Evere�t �rom any and all claims tor damages, cosis, <br />expenses, or causes of action that may arise because ot installation <br />and maintenance of the improvement or o�her righboFway use hereto <br />applietl for and further agrees to remove same upcn notice trom the <br />City and��l o replace p blic prqAerty da aged thereby. <br />' .� �� � � � , <br />�� � � ' u:T. % �' � �-�-K--- � - "2v ���� <br />Signatnre ot Applicant Date <br />t'JORK AUTHCRIZED BY THIS PEPMIT MUST BE STARTED WITHIN <br />lA0 DAYS OF DATE PERMIT IS ISSUED AND THE�IEAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERFAIT MAY BE <br />CANCEI_LED BY THE CITY UPON AMY SiOPPAGE OF WOFK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />