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Date���c�'�` <br />Application For <br />PU�LIC WC�RKS PERMiT <br />Print or Type Only <br />ApplicaM <br />Describe Proposed Work <br />Mailin9 Atldress <br />Froject Address (il known) _ %/D �— / ���� Sh- <br />c��y <br />City <br />Puaq_ \tio'k:: Permil .- �v r ������ <br />em�. u�oi. e ���Zp�''� <br />PubLc AVo�ks Fae �, <br />�o1al'rco <br />Le:.s FPPL Fec Pai� � <br />�J/� 1 <br />palnr.ca.0un $:�(B�♦ <br />Lr,;�^, 9 �,�s.G �=53 =zc�7„�. <br />Zip Phone <br />7_ip Phone <br />A�tac h four (4) copies of plans for proposed work - Draw �o scale and note the following as applicable: <br />• Property Lines • Centerline of s�reet <br />• Outline anC dimensions of ali existing and • Indicate Nor[h <br />proposed structures on ihe lot • Show any proposed g�ading changes <br />• Existing 2nd proposed ulilities • Show measuremenis <br />LINE <br />PERMIT CONDITIONS <br />1. All calls for insp� ction sh,il be made 24 hrs. in advance - phone 259-881 O. <br />2. All worl< eh:,tl be performed in accordance with this permit and curreM City of Everett Design and Construction <br />5tandards and Specifications. <br />3. Call Location Underground Scrvice 48 hrs. before you dig. TOLL FREE NUMBER 1-500•424•5555. <br />l,Gd•!Y CfIAN[�E Ii�! IIIF I]RII�Et��nY CUT P1U;�T F4E= Fl�'F"ROVEi' <br />':'( THC PUBLTC WOF.�:S IN ;F'ECTOR, <br />S.IiS� F'UE:LIC Dr�AINFIGE i'tiSTEPI AS F'ROVT,DED FOF� 'e.l(IW,d`:F'l1i.f-f". <br />„!li�;`! I_Ol" GR(1DE CHANrE�i h1UST EiE AF'FF.C]V_D EtY Tlic: <br />FliE�i..1C WURI:::� INSF'ECTDFi. <br />I':E�_I' CIT`! ST�i[itTS CLf-lap! AT ALL 'fIMES. <br />I'Vf:'l'ALL I�JFIl"ER BOX�S TO GRADF (1T TFIF EIuD OF CCiP�"'TItlJCl70r1 <br />;, 11(-lk::� surr_ DRI VEWAYS 11�I- COI1F'LETF3L.Y (71;RC-:D E�EI=OFit'_ <br />1�r;f.��T.NG ON THFI•1. <br />i�+,�-�:''•I`; DAM(-11��E TO TfIE CL�FiF� AIJD :'1GEWAt_k:: idII..L. F�F RFI='At.Fi[=i) <br />. IrJ l'FL� !1T[ql=^���rrnP• �1- flll' "�UCI.;r �ir)f; :' n�-f�T. <br />� � <br />`_ 2`` -.�rr�� � Z9 89 <br />Appr�ved for Construction - Date <br />a <br />��,aG�, bc. f �..�:' n:.cw,.: � �r/��roi•�.i <br />('�.e t., .�.�.r.- co,�-� Sen..v�.c� S/u..f c'. <br />FINAL INSPECTION ate <br />Approved as Conslructed <br />everetl PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett WA 98201 <br />Phona 259�8�310 <br />� 'i <br />o ' <br />ACKNOWLEDGEMENT OF CONDITIONS <br />1ho unaeisigned ownedappllcant hereby agrees to hold and save harm- <br />Icss Uia Cdy of Everel� trom any and all claims for damages, cosis. <br />expenses, or causes ol �ction lhat may arise because of installation <br />and maintenance of ihe improvement or other riyhl�of-way use here�o <br />applied for and turthe� ac�rees to remove same upon r.otice trom �he <br />City and to replace public property damaged thereby. �,/ <br />�������"r��, ��`� tSfS <br />Signa u� re of Applicant Date <br />WORI! AUTHORIZED RY THIS PERMIT MUST OE STA9TEC WITHIN <br />180 DAYS OF DATE �'ERMIT IS ISSUED AND ?HERF.AFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS �cRM1T MAY BE <br />CAIJCELLED BY THE CITY' UPON A!'!Y STOPPAGE GF WORK ON THIS <br />PRVJGCT QVER 90 DAYS DUR�;TIUtJ. <br />