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-1. ' r 1 <br />�..:� �� .' . <br />. . . ., .i � 'u' . '"„ . .' y .+r:. ' .,�;; ,' . . <br />Date 1/24!9C. <br />Application For <br />Pu��ic wc�c�Ks P��r,neT <br />Print or Type Only <br />_ <br />.. r� . i .. � ' , . j" <br />Select lIomes P.O. 20^ 70F3 '?'P.:iltao; t.�+l-. .^-9?7` <br />Owner Nailing Address Citv <br />r.^:7 .?1�y <br />Iniinlir.Wo�ksPermit+ C <br />�me oeai.. 90/23, 13 <br />Pu�Lc Works Feo <br />Total Fee 5 <br />Lrss ApP�� Fee PnN S <br />9alanca Due $ 7 � <br />Phene <br />Ci71f_'1 <br />Applicant Mailing Address Ciry Zip Phone <br />Descri6e Proposed Work _�Ir_w sinale f.ffin'r.x famil•p resir.�_ c•e_Lo` 11, "]enha.v�n �?eights <br />Project Address lif known) �7l J� <br />A�tach �our (4) copies of plans br proposed work - Lr�w to scal.. ��tl note �he lollowing as applicable: <br />• Froperty Lines • Ccnterline of street <br />• Outline and dimensions of all existing antl • Indicate Norlh <br />proposed structures on ihe lot • Show any proposetl 9rading chenyes <br />• Existing and pror�=?d utilities • Show ineasurement� <br />�Iq <br />PERMIT CONDITIONS <br />t. All calls !or inspection shall be ma fe 2a hrs. in advance - nhone 259•8810. <br />2..411 work shall be performed in accordance with this permit and current City of Everett Design and Consiruction <br />Sfandards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424-5555. <br />�.�^.tiY �:-nr.tir.,c iN �'liL n7;zve'v1n, co�r t�risl� i,L e��t��xuv��:,�� <br />BY TE{E FUBLIC WORKS INSFECTOR. <br />:5 . COIVP]FCT DUWt(SFOUTS TO . �, , ., . t-tiE.�i �. Grc�l� N9e;�� ;�,_�� ,—�= r�l <br />!,.BEGF CITY STFGFTS CLrAId P,1 ALL TIML:S. <br />"i-ANS' P^H1�C]I;'P� T�iR ('pEF Atd� '�l�DF1,�`^i�F. l•dll.t, i'i�. ri�',1`:-,;;r <br />7�i i'I�; '�'I�1:'� �, ' 1 '�! ' 'i'i r�„�. <br />� �Pp � i�l �� <br />Aporoved for Ccnstructio Date <br />� <br />�� -j�–,�i �'v <br />FINAL INSPECTION Date <br />Approved as Con ,tructed <br />i everett PUBLIC WORKS DEPARTMENT <br />� 32U0 Cedar Street <br />iEveret , WA 98201 <br />I � Phone:259�8810 <br />ACKNOWI_EDGEMENT O� CONDITIONS <br />The undersigned owner/applicant hereby agrees to hol� and save harm� <br />less the City of Everett from any and all claims lor damages, costs. <br />expenses. or causes of aUion that may arise because ol installation <br />and mamlenance of ihe improvement or other righ�-of-way use herelo <br />applied foi and furiher a�rees to remove same upon notice Irom Ihe <br />^i'; and �o replace public property c'amayed thereby. <br />—�� �,. <br />' i.�.� > - �i. � <br />SignaWre of Applicant Date <br />WORK AUThIORIZED 8Y THIS PERMIT MUST BE STARTED WITHIV <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAPiER F� 1�O <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY tiG <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON Th{IS <br />PROJECT OVER 90 DAYS DURATION. <br />