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l. / ; -_' C. ._ <br />Dale���0 <br />.4pplicatio� For <br />PUBLIC V9�+fJR�;� €�ERMIT <br />Print or Typa Only <br />/3 PC G <br />Owner <br />Mai <br />SQa,,,.p , _ <br />Applicant Mailing Address <br />Describe Proposed Work <br />Prolect Address (if known) <br />Cily <br />Atlach four (4) copies of plans for proposed �.ork - Draw to scale and notr, ti�e following as applir.able: <br />• Property Lines <br />• Outline and dimensions of all exisling and <br />proposed siruciures on the bt <br />• Exisling and proposed u�ilities <br />PERMIT CONDITIONS <br />%'.. �: - <br />�., <br />Pu�lic Warks Pvmit a _ `�' ��c�� _ <br />BlypDeotr �� �lD6oZ� <br />^u�lm woike Fee <br />f�tal Feo 5 <br />Less ApDL Foe Pald $ _ <br />Bamncc Due $ <�Q n� <br />• Centarline of street <br />• Indicate Norih <br />O Show�any proposed grading changes <br />• Show measuremenis <br />Phone <br />1. All calls lor inspection shall be made 2C hrs. in aCvance - phone 259-881 S. <br />2. 411 viork shall be performeG in accordance with this permit and current City of Everett Design and Consvuction <br />S'andards and Specifications. <br />3. Ca'I Location Underground Service 4A hrs. before you dig. TOLL FREE NUMBEH 1•S00•424-55$5. <br />� .iUL' �LG �U/Ti�%!/T fJ?pj�E,� ��2i�Ji%,.S <br />,�! .9cc ,:c=G9��•ic /�9%���HL ��/sr BE ,PEmo✓Ev <br />D.P ,d�i.e.dEO - wiTif PC.e.ni; . <br />�-��j1t�✓ �C7?%� / c�.��cg6 <br />Approvedfa�Construciun � ,-'Date <br />���%�c }--z-��l� l� <br />FINAL INSPECTION ( \ Date <br />Approved as Construcled V <br />rvereit PUBJC WOfiKS DEPARTMENT <br />� 3200 Cedar Slree� <br />Everelt, 1NA 98201 <br />Phone: 259�8815 <br />ACKNOWLEDGEMENT OF CONDIT'7NS <br />W <br />H <br />� <br />� <br />O <br />The undersigned owner/applicanl hereby eu:.-�es to hold and save harm- <br />less ihe Cily ol Everelt Irom any and all claims for damages, cr,sts, <br />expenses, or causes o chrn that may arise because ol instaltation <br />and m tenance ol/the mprovement or other right-ol-way use hereto <br />appli d I and fur,ihe a�rees to remove same upon notice Irom the <br />City a d t replack lic property damaged �hereby. <br />Signatur of Adplicant / Dale <br />WORK THORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />iQU DAY,,, OF DATE PERMIT IS ISSUED AND THEREAFTER IS Tq <br />BE �ILIGENTLY PURSUFD TO COMPLETIOtJ. THIS PERMIT MAY BE <br />CAPICELLED BY THE CI7Y UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />