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�� a ..� 1 t� ' __ _ <br />Vwi ( <br />I •2•�.., �i � Ylit:t R,J �. , ♦ �.',r Y ..{+`,I ,. _ �if}. t p . ` . . . <br />. � p "{�) �!.'+. rJ �I <br />Date '� ,�'� , <br />� Applicztion For <br />I PUBLiC WOF;KS P�RMIT <br />Print or Type Only <br />C__ J� � \ <br />Owner <br />u i1 <br />Applicant <br />Describe P�opose�� Worl; <br />Projecl Addr� ss (if F � <br />Mailing <br />Mailinq Address <br />City Zip <br />_ _— -- _ f.. --- <br />PueLc Works Permil +/�, <br />B'ay. �enl. ♦ ( 1 v' _ �� <br />a�ni�cwo�xsr�„ — <br />roial Fee S <br />Less Appl Fer Patl $ <br />Balancc pue $ % F% <br />Atlach lour (4) copi�c �lans for proposed work - Uraa ;o scale an;. ^.�te ihe following as app�icabl�:: <br />• Property .ines • Centerline of sheel <br />• Oatline and dimensions ol all existin9 and • Indicate horth <br />proposeo st�uctures on the lot • Show any proposed gradiny changes <br />• Exisling and proUosed utilities • Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls (or inspection shall be made 24 hrs. in advance- phone 259•8810. <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Consiruction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. be(ore you dig. TOLL FREE NUMBER 1-$00•424-5555. <br />AtdY CNANGr II�T TH}s' DF'.IVLWltP (,J`�' MU�1' EE FPYFt!'��iE�i'� <br />BY THE PUP,LIC WORZS INSPGCTOR. <br />CUPIPIEC7' DOWNSFOUT� TO FOSi,IC DRAI�qGE SYS'I'CiC1. <br />1:1"sGP CI'PY �TR[:GTS CLI:4N AT �LG TIMh'S. <br />ANY DAC1AGEs 'PO THE C�JL+1: AlsI� i;'fD[:F��9LA N;II�L BE F.A:1'GT5P:1�� <br />'1'G 7'IIr :'�,TTSrAC'P7iii1 :'�)� 'I';iP: FU!?CT: �ar,R1':;', ,)I:L'7'. <br />r <br />:�r�, <br />�Qra 4�� � z Il� <br />Approved for Con�truction �a e <br />- ����---��0 ��� ` >��/ <br />FINAL INSPECTI�7N Date <br />Approved as Conetructed <br />ev�rett FUBLICWORKSDEPARTMENT <br />� 3200CedarStreet <br />Everett, WA 98201 <br />Phone:259-8810 <br />ACKNOW�EDGEMENT OF CONDITIONS <br />The undersic�ned owne�/applicant hereby agrees to hold and save harm- � <br />less ihe City of Evere(� from any and all claims lor damages, costs. <br />expenses, or causes ef action that may arise because of installation �' <br />and mainteoance of the mprovement or other righbof-v�ay use hereto <br />applied for and fur�her ag�ees to iemove same upon notice from the �'� <br />City ard to replace public property damaged ihereby. � <br />v <br />:a. ? j' ,i• � <br />Signature o� Ap ic8nt Dafe <br />WORK AUTIIORIZED BY THIS PERMIT MUST 6E STARTED WITHIN <br />180 DAYS OF DATE P[RMIT IS ISSUED AND THEFEAFTER IS TO <br />BE DILIGENTLY PUF'SUED TO COtv1PLETION. THIS PERMIT MAY D[ <br />CANCELLED BY 1�+F CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 D.4YS DURATION. <br />