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Date_��L.�S <br />Application For <br />I�UBLIC WOF�KS P�i�MIT <br />Print or Type Only <br />�`� <br />Owner <br />\ <br />Cilp ' Zip <br />P�on� wo,k: F fmy� c�5 37'L <br />eiae. oaai.., 5 .� .7 <br />Fuelic Worxs Fca <br />ra�a� Fae $ <br />LC5911ppL FOB FdiC `S <br />ealance Due $ 2� n-�- <br />��'r� <br />Applicant Mailing Addrass City Zip Phone <br />Describe Proposed Work <br />Project Address (i( lanown) ��5/�S— � Y�'.�'P S� <br />Atlach lour (4) copies ot plans tor proposed woik - Draw to scale and note the folL�.ving as applicable: <br />• Property Lines <br />• Oulline and dimensions ot all existing and <br />proposeo atructures on the lol <br />• [xisting and proposed ulililies <br />PERMIT CONDITIONS <br />• Centerline of steet <br />• Indicale North <br />• Show any proposed gradin9 changes <br />• Show me2surements <br />t. All calls lor inspection shall be made 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be performed in accordance with this permit and current City of Evereit Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before You dig. TOLL FREE NUMSER 1•S00•424•5555. <br />ij�, .�.r/� �'��O�•t/G- �o.c.� CN Ti/E Lc�T Sf/GCC dE <br />DaUE JO A.l NoT ��' Tin�'4L'T TL/'� Sv/'c'o��ND��v'�_ <br />GoTs�t .PA..c/ �.�erF::� ,c�:�.� of`�.� <br />�,�,iN <br />7 <br />S :�cu'.��—z- � <br />Approvedfor <br />FIN�1L INSPECYiDN l ` <br />Ap/proved as Constructed \ <br />I tvere« PUBLIC WORKS D <br />� 320U Cedar Street <br />Everett, WA 98201 <br />Phone:259�6815 <br />Dat� <br />ACKNCWLEDGEME�T OF CONDITIONS <br />� <br />� <br />The �.rdrr:;'3�^d owraya, �'icant hereby agrezs to hold and save h,vm- <br />less the �ity d Everetl trom any anrl all clairs for dama�ns, ce�sls, <br />expenses, or causes of action Ihai may arise because of installation <br />and maintenance ot the improvement or other right-ohway use hereto <br />ap for and ' rt i r agrees to remeve same upon notice Irom the <br />Cil an to repla�e c prnperty damaged ihereby. <br />` ��,; \� '�1 cS' <br />Signature of Applicant Date <br />WORiC AUTHORIZEL iY THIS PERPd1T MUST BE STARTED WITHIN <br />180 DAYS OF DATE PGRMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLE i ION. THIS PERMIT M11AY BE <br />CANCELLED BY TFIE GTY UPON ANY STOPPAGE OF N'ORK ON THI : <br />PROJECT OVER 9P DAYS DURATION. <br />