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Date Z � .� <br />Application For <br />�UBL�C WORFCS PEF�MIT <br />Print or �ype Only <br />��.�--�- <br />Owner <br />Mai{inc� Address <br />Mailing Addres: <br />���.�1-{��; Uc-� <br />City Zip <br />City Z:,> <br />I�/� "' ��7' G � <br />Describe Proposed Work ���L <— 7, �___ <br />Project Address lif known) <br />Altach lour (4) copies o( plans for proposed work - Draw to scale and note the followi�g as applicable: <br />• Property Lines <br />• Oulline and dimensions ot all existing and <br />proposed structures on the lot <br />• Existing and proposed utili�ies <br />PUUIm LYoiFs Pcrmi�� v C� J" _ <br />Dl�g Oepl. s � _�_ � <br />Public Wo�ks Fcc <br />Tolal Fce � <br />Less ApP4 Fcc Vaid S <br />Balance �vc � �� <br />• Centerline of street <br />• Indicate Norih <br />• Show any proposed grading changes <br />• Show measurements <br />LINE <br />�z�-�'� <br />Phone <br />Phonc <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be perlormed in ac,:ordance with this permil and current City of Everetl Design and Consiructicn <br />Standards and Specifi��tions. <br />3. Call Location Underground Service 48 hrs. 6efore you dig. TOLL FREE NUMBER 1-800-424-5555. <br />4.AIVY CHl1NGE IN THF DRIVEIJA`( CUT MUST E+E 11FF'fiOVEC� <br />RY THE PUBL.IC WORh;S It�IcF'ECTOR. <br />6.!JONIVE°CT DOSJNSPOUT, TQ FUE+1_Ir Dr�Ip,�q�E SYuTEl1. <br />,S.I::EE(P CITY S"fREE.'fS CLE:hN (1"f ALL. TIt1E5. <br />7.AN1' D6�MFIGE TO THE I'UFiE? ,'-1ND SIDEIJAI_I:: t�1ILl_ itE F'(EP(U:;=(rp <br />T(7 ll-IF S(1TSSF'ACTI01� OF THE F'Uf:l_r� Idn�il:E, UI::F'T. <br />--I--c�e�,l'_ 49�1 �k� z/��+/9�� <br />App�oved for Construction � D�te <br />' �� <br />n ���j � �—�G /% - f � <br />Li/� <br />FINAL INSPECTIOP' Cate <br />Approved as Constructed <br />everett PUBLIC WORKS DEPART1dENT <br />� 3200 Cedar Streel <br />Everett. WA 98201 <br />Phnne:259�G810 <br />�CKNOWL[DGEMENT OF CONDITIONS <br />W <br />H <br />_ / <br />"� <br />The undersigned owner/applicant hereby agrees to hold and save narm- <br />less ihe City of Everet� from any and all claims for damages, costs. <br />expenses, or causes of action that may arise 6ecause of inslallation <br />and maintenance of ihe improvement or other right-of-way use hereto <br />applied for and further ac7rees to remove same upon notice fr<m ��a <br />City and to replace public property damage[}�thQ{eby. <br />Signa�ure of ApPlican� � ' � � DAte <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STAFTFD WITHIN <br />780 DAY$ OF DATE PEfiM1T IS ISSUED AND THEREI,FTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PER"NT MAY B[ <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />P�^OJECT OV[R 90 DAVS DURATION. <br />