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Date���G <br />! <br />l ' <br />Application For <br />�'UBLIC WORKS WERMIT <br />Print or Type Only <br />Address <br />Describe Proposed Work <br />�,, <br />Zip <br />Pu�lic Y:orkS Po�mit > �� — �� <br />eiae� ono�. � � , �— <br />Pub4cWo�ksFen 5 <br />Tolal Fed <br />Le55 APP� FPC Pai� � �� <br />Balance Oue � � a <br />Piolect Pddress(if kr.own) " ��--=�— � <br />Hltach four (4) copies of plans for proposed wo�k - Draw to scale and note the following as applicable: <br />• Property Lines <br />• Outline and �imensions ol all existing and <br />� proposed structures on Ihe lot <br />/ • Existing and proposed utilit es <br />• Centerline ot street <br />O Indicate Norlh <br />O Show any propos.�!':ading changes <br />• Show measuremen,s <br />3,S ,3 - G.Sc� <br />PEFMIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs. in advance - phone 259•861 5. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Cal� Location Underground Service 48 hrs. before you dig. TOLL FFEE HUMBEP • d00•424•555 . <br />� Lor s•Y��.� aE G.¢AUEo so fIS NOT ro r�,.��<;- <br />Su�2,eov�/D.:r/Cr LoTS GJ�:•v .PiAirrr<vl1T« .Pf(�/OFF <br />s ,S.oEuJ�Ick is NEuJ ,9�✓a �in/B,�c�='E^�� .Auy �9m9v� <br />SyqlL ,8E .QEr�'9cE0 �/ rNE A��c�c.v�✓T, <br />�j .�L�.�C/I/Vl�ti—�G."T�"� i� .. <br />r ri <br />- r E�.�a- <br />�.oil/OH.PQ �"�0�. <br />F�G //<�G�r -- • �.� .�_ <br />��'o�✓s-r�ucT—��—A/irJ__,�EiE'-Ciijr—.�iP�d�Fn',ed—�rr�; <br />PF� t.s'.�'�zy ` G <br />�l' b�C � Z ��� S(�" ��q�NO`.NLEDGEMENT OF CONDITIONS <br />Date <br />FINAL INSPtl:nvrv / \ <br />Approved as Constructed �J <br />ever<tt PUBLIG WORKS DEPARTMENT <br />� 3200 Cedar Siree� <br />JEverett. WA 98201 <br />Phone�.259�8815 <br />� <br />� <br />The undersigned c:!n^;; applicaN hereby agrees to hold and save harm- <br />less lhe City o' Everetl (rom any and all claims tor damages. costs, <br />expenses, or causes ot action ihal may arise because ol instatla�ion <br />and maintenance of lhe improvement or other righFol-way use herelo <br />applied for and lurther agrees lo remove same upon notice trom the <br />Ciry and to replace public proGerry damaged thereby. <br />i • <br />�_---���� ' n' � , <br />licant �� <br />Signa�ure � f App' <br />aORDAYSTOF�RDATE� PEHMIT ISEISSUED ANDBTHEREAFTER ISHTO <br />BE DILI�ENTLY PURSULD TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />