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- -- -- {�� ? <br />. � 1,. w .� -.�"k. i�•.'�q�� �}p��C!" :' � Y i� a��rr <br />��5.f �' � i�t oi i�.' .1`In.�. �li'WH' 19�� <br />I � �(J n �1 1 M�{.I.�.J l..{�� • <br />Date� r-+�J <br />Application For <br />��JBLIC 'W�Rl�CS PERMIT <br />Print or Type Only <br />Applicant <br />ress <br />��' 1�1 <br />.�. .'�J� i - <br />City Zip <br />j�� <br />Pubiic Works Pcrmil + C"Lp�,/ �� � <br />/'-''��' � <br />omq. Droi. . �E� � <br />nuel¢ warks Fn.c <br />Total Fee S <br />Less AoOt Fee Parzl 5 <br />F3alancc Due $ �� <br />Phone <br />Deecribe P�oposed Work f/�-�.� � � %Y—����— r7 ! ^��� / '��I <br />—.-�-�c��.� � ` =�—�--- <br />� <br />Project Atldress Iif known) <br />;.� C", 2- �� il�, ,^�; �: t-.1 �.�T <br />v <br />Attach lour (4) copies of plans for pr000sed work � Draw to scale and note the fohowing as applicable: <br />• Propzrty Lines <br />• Oulline and dimensions of all existing and <br />proposad structures on the lot <br />• Existing and proposed u�ilities <br />• Centerline ot street <br />• Indicate Norih <br />• Show any proposed gratiing changes <br />• Show measurements <br />LINE <br />PERMI! CONDITIONS � <br />t. All calls (or inspection shall be made 24 hrs. in advance - phone 2�9-8810. <br />2. All work shall be performed in accordance with this Germit and current Ciry of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. helore you ciig. TOLL FREE NUMBER 1-$00•424-5555. <br />��L�. �'.l ��t'7�E ["� ..k[� URIVE4JllY CUT '�iUS'I' T'i: ^1I t'l')L�i:,I�� <br />1 ,l:l� �IHI�?(' � 06YS IP]:,FEt;TQG. <br />l,Of�t•tGC 1 DOWPl�FOUTS TO PUBLIC DRAINA';G SYb7 � 7f <br />hTsEP � l'"v f�1'REC'fS r1.T'Al1 t1T A[�L TIMti <br />AtIP DP11f'�F 7'�� 7'IiI�: r��t'P .".�III ^,rf1F.i'�ALY; TLL :.. . i:. 'ji <br />��� "H1 ^.�a�-c,I' �,9I�.:? �i� 'CII�� . ni��l,TC !�1('� � P� <br />�� � � �� <br />AnnrovedforConeuuc'on / D te <br />— ��L � /Q ' �% �� <br />FINAL INSPECTION Date <br />Approved as Constructed <br />euerett PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everetl, WA 98201 <br />Phone:259�8810 <br />ACKNOWLE�GEMENT OF GnNDITIONS <br />The undersi9ned owner/applicant hereby agrees to hold and save harm- <br />less ihe City of Everett from any and all claims : damages, costs. <br />expenses. or causes of acticn that may a�ise because of installatior, <br />and maiMr�nance of �he improvement ur other n9ht-of-way use he�e�o <br />applied lur and iurthcr agrees lo remove same upon notice Irom ihe <br />City and lo replace public property damaged thereby. <br />_L-, = ' . � �..-. 7 . /� - � <br />Signa(ur of Appli ant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST B!. SiARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND iHEREAFTER IS TO <br />BE DILIGENTLY PIIRSUED TO COMPLETIGN. THIS PERMIT M11AY E3[ <br />CANCELLED BY THc CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DFlYS DURATION. <br />