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Date�32_� �l <br />Applir,ation For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Mailin� Address <br />Mailing P,ddress <br />City Zip <br />PUFnc 1Yorks Porml� a _ �_�/ � _. <br />eltlg. oepl. + C YL�_ <br />Public Woiks Fm <br />To�al Fee $ <br />Las5App1 Fee PaiC '�'u _ _�__ <br />�� n o <br />tlolnncc Due $ <br />Phone <br />Phone <br />Describe ProPosed Nbrk r1;11,1) S Tl�___hG � i d ��,� �'�l� �J� — <br />Project Address (it kno�m) � �7 n%— � r� ����_l� ___ <br />Attach four (4) ccaies of plans tor proposed work - Draw to scale and note the fodowing as applicabie� <br />O Property Lines • Centerline of street <br />o Outline and dimensions ot all existing and • Indicate North <br />proposed strucWres an the lot • Show any proposed grading changes <br />• Existing and proposed utilities s Show measurements <br />PErIM1T CONDITIONS <br />t. All calls lor inspection shall be ma�e 24 hrs. in advance - phone 259•881 5. <br />2. All work shall be pertormed in accordance with this permit and current Ci�y of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Undergruund Service 48 hrs. before you dig. TOLL FREE NUMBER 1-Li00•424•5555. <br />_ , � �. , ,. , � . . . . . .. � ... . .. <br />,..iJ�L' r'IJ���.T_C DF:AZf.I�G4 �,?�::.- � �� : r�.i r. :-n,, <br />r;t:!Y !._CT [ifiADF: GrAIVC': <br />i �;i_:[C Wl.-�Rk:S t�ic�.='r,- <br />_ =i C;71"Y Sl"RFcTFi C:' <br />_"!-''oLL 4!(-?7ER F+�;��^ Ti] �;=ii-illE rYi <br />, .. , _ <br />�.ir_ r: . - ; i <br />��� , , <br />.� � <br />� �' /J � IJ/ J y <br />�'- �:.r" ri':'�!LT;•-./^',-�-- .�l+j�',i ,-��7 <br />Approved for Construc�ion Da�e <br />FINAL INSPECTION <br />Approved as Con=tructed <br />everett PU�LIC WORKS DEPARTMENT <br />� 3200 Cedar SGcet <br />Everett, WA 98201 <br />Phone: 259�Bf315 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersic�ned owneUapPlicant hereby a9rees to ho!c' ard savo harm� <br />less Ihe City ol Everett trom any and all claims for damages, costs, <br />expenses, or causes of action that may arise because ol installation <br />and maintensrir_e o( Ihe improvement or other riyht-ohviay use hereto <br />applied for antl further ayrees tu remove same uncn ro��.:e (rom thc <br />City and to replace public property dama9ed thereby. <br />i <br />Date --�J I'-:���,L-/�(�2�� ,�/�i-/3-=Y, <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS P�._HMIT MUST 8[ STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTEF !`� TO <br />BE DILIGENTLY PURSUED TO CO�dPLETION. THIS PERMIT D.11�Y DE <br />CANCELLED BY THE CITY UPON ANY STOPPAGL OP 4:�ORk, GN TI{IS <br />PRGJECT OVER 90 DAYS DURATIOfJ. <br />