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Date ����f�j� <br />� <br />PU�IC <br />O <br />O <br />0 <br />Print or Type Only LL <br />.4-� <br />ti <br />� �� � <br />Appiicant <br />Describe Proposed VJork <br />Project Address (if known) <br />Application For <br />WQRKS PERM17' <br />1 fJ O O C� O O O p O C�' � 1 <br />OJInInOJO O O pOC� <br />Il� W Ou�C+RJ W M.�-a��111�f] <br />W W W b! .r <br />C� ' �.�,�a=,��c¢ t� ��%e. / %( <br />� G] [.=J Z��'�'L- p 3 p� u <br />W 2LiJi�aaa�uim.�-i[_=J <br />Mailing Address <br />,... �� �� �., �/., l�n,,�,i _ / <br />�td���S <br />Cily <br />cuy <br />� <br />Public Works Permil < t � <br />Bltlq. Dep�. a �_t ��_��_ <br />PubLc WorhS Fee 5 <br />Total Fee — <br />Less A, pl. Fee ParJ S <br />� p� ..� <br />B�lancc Dun S f��V <br />ass� �sc � <br />Zip Pione <br />Zip Phone <br />Attach four (4) copies of plans for proposed work - Draw to scale �nd nole the lollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all exisiing an�f <br />proposed structures on the lot <br />• Existing and proposed utiliGes <br />• Centerline ot siree! <br />• Indicale North <br />i Show any proposed grading changes <br />D SP�ow measuremen�s <br />PERMIT CONDITIONS <br />1, All ca!:� f�r inspection shall 6e made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accordanr,e with this permit and current City of Everett De.=,' <br />Standards and Specitications. <br />3. Call Location tlnderground Service 48 hrti. before you dig. TOLL FR=E NUMBER '-800 <br />•=I, G�'Nti��-T: PO�.INSf�u�S 'To '"'1—I�N=�-� C.c�rLb D/GhtN, <br />a� � Construclion <br />-5555. <br />5� K�'P G� T`�1 5'i�=�=-'iS GLExrtJ A-'� hC.t, T/MEi <br />�o. A��l`( (,�hiflkSE '!'o� Lu2�S/i�✓t�J S�JE�✓itt-K S/i�t-L- �E 21=F'h12C7> <br />7U rHE s�7—,5r;��Tr�r�J c�= �7rE la.r5c..�� ��o�s �?�r; <br />_____��!iY1� -;'/��/9� <br />Approved for Gonstrrction r ��efe <br />��� Y ��� �. <br />i= �i <br />FINAL I SP CTION Date <br />Approved as Construded <br />everett PUBLICWORKSDEPARTMENT <br />� 3200CcdarSireet <br />Ever2tt, V/A 98201 <br />Phone:259-8810 <br />ACKNOVJLEDGEMENT OF CONDITIONS <br />W <br />� <br />�1 <br />_ I <br />/� <br />� <br />The undersigned owner/applicant hereby aar �s to hold and save h�rm- <br />less tl,e City of Evere�t irom any and all aaims foi damages. co:.ts, <br />ezpenses, or causes of action that may arise because of insta'iation <br />and maintenance cf the improvement or other right-of-way use iere�o <br />applied for and for,her agrees lo remove same pon notice frcm the <br />Cit,y and to replace public property damagecj��he�r�by. <br />SignaWreotAppucam � � ���e <br />WORK AUTfiORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />tA0 DA/S qF DATE PERMIT IS ISSUEG AND THEREAFTER IS TO <br />BE DILiGENTLY PURSUED 1"O COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY TI1E CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJFCT OVER 90 DAYS DURATION. <br />