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Date ;� ;�, L�� 4, <br />. i <br />Application For <br />Pl1�LlC WORKS PERMIT <br />Print or Type Only <br />n! <br />Describe Proposed Work <br />Prolect Address;if known) <br />Mailina Adtlress <br />Mailing Address <br />i <br />d v l i r l;iu� <br />�_���,, <br />�� � r_= r�,::,; <br />Citq <br />City <br />PubL[ 1':o�As Pnrmil a _ (�G� ~ �L <br />�ia9. Dco�. a `��' n � '�'1 � '1 �if� <br />PublicWoiksFee S <br />Tolnl Fee <br />Le55lppl.FcePaW S <br />fi:'anceDuc $ :��� nC <br />� ,� <br />:� , 7 -�-_�,, e, <br />Z p Phore <br />Zip --� Phone <br />Altach four (4) copies of plans for proposed work - Draw to scale and note the lollowing as applicable: <br />• Property Lines • Centerline of street <br />• Outline and ciimensions ot all existing and • Indicate Norih <br />proposed slructures on ihe lot • Show any proposed grading changes <br />• Existing and proposed utili:ies • Show measurements <br />PERMIT COND�TIONS <br />t. All calls br irpec�ion shall be made 24 hrs. in e.dvance - ohone Z59•$B� 5. <br />2. All work shall be perfurmed in accordance with this permit and cu�rent Ciry ef Evere�t Design and Construction <br />Standards and Specitications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />� S��rG�IAG,C" CCI�B � CU/%G`� �/'FE U201'f��-i✓ �. jV <br />,�s!.++%i,cp'�� iuicc a'E ,E'EPC/�cEo �y Q//_�c:�',��,✓i� <br />�J /iOc•1•�- !iC[<.st'Sr'OdT:S' �.te-- Tc � /�E - 7iL-ir --.Cit-�-! %C� %i�e <br />%IG�G�'LiC lJ.f':�>�n/P� E aSf/STF./1�- <br />�, , �,vy G-p%'nii✓G O�/ TiE Glr7 T' 8£' lJL�/E sc ,�lS .cJO% <br />T//-r . .w�-,cCL''Ge.i.�lJii✓C— <br />%D /�ni°..nG i <br />� � i � <br />� :�. / i i;. c�J9ic,c"' it'i-:Ut°h' . <br />�CT.s" � %� <br />�-C � 1,-Y'c-r•fj:., 3,Z,��� <br />Approved for Const c'� m 'Date <br />- z�31 , <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />everett PUBIIC N,�ORKS DF �ARTMENT <br />� 320G Ce�ar Street <br />Everett Y✓A 98201 <br />Phone:25��8815 <br />ACKNOWLEDGEMENT OF CCNfI!?iJNS <br />Z <br />� <br />The unders�gned owner/applicant Y,e�aby a�arees to hold and save harm- <br />less the City ol Everett from any and all claims lor damages, costs, <br />expenses, or causes of aclion ihat may arise 6ecause of installation <br />and maintenance ol the improvemeni or othcr righPof-way use hereto <br />applied tor and luriher agrees to remove same upon nnlice Irom �he <br />City and to replace public property damaged thereby. <br />�' <br />Si n ture of Applican Date <br />WORK P.UTHORIZE BY THIS PE!iMIT MUST BE STARTED WITHIN <br />iB0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTcR IS TO <br />BE DILIGENTLY PURSUCD TO COMPLETION. THIS !'ERMIT MAY BE <br />CANCEI.LED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />