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Date� �� �� <br />Applicatior. For <br />PU�LI� iNORGC� PERMIT <br />Print or Type Only <br />Applicant <br />ng <br />Mailing Address <br />City <br />Describe Proposed Work ��� I� �� Y�.�5 1` 1 �� <br />Project Address (il known� <br />� <br />Pu01ic Woiks Vermil • L��—�"(""�j <br />BItlO Depl. s__ 1�1 J� L_%_��-L/__I..:>- <br />Pubbc Works Fcc S <br />TalalFec <br />Less AOPI. Fee Pal� S <br />L�7�— <br />Balance Due $ G � -/ <br />Altach four (4) copies of plans for p�opcsed work � Draw to scale and note the following as applicable: <br />• Property Line� • Centerline ol street <br />• Outline and dim�naions of all existiny and • Indicate North <br />proposed st« ic�ures on ihe lot • Show any proposed gradin� chanyes <br />i Existing and proposed utilities • Show measuremenis <br />DO NOT WRITE BEL <br />Phone <br />PERMIT CONDITIONS <br />1. All calls (or ins�ection shall be made 24 hrs. in advance - phone 259•8810. <br />� 2. All work shall be performed in accordance with ihis permit and wrrent City ol Everett Design and Construction <br />� Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBEF 1-800•424-5555. <br />4,l1NY CHFdVGGS :RQ TNE 6RI�'LIdAY CUT PIUST E:c: l-11='F'hOb'Ei:• <br />EsY iHE F'Ubl_J:C lJOfil'CS INSF'ECTOFi. <br />S,USE PU$L.IC DRAIIVA6F- SYSI'FM AS FROVIDLD I'OFi U0�'11`;'GF'1'UI�. <br />6.Fll�l\' LO'f 6RAlSE CIiAR!{7ES PSU�T NE (1F'F'ROVED E�l' TFIE'. <br />F'UBI_Ir, WQFiI::S IIV�iF'CC"I'pf.`, <br />'1.1�:EEF' CIl'1' `�TREETS' CLF_(1N fff ALI_. 'I IMFS. <br />f �:N�T(1LL lJ(1TF_Fi EQ;CES l'0 GF:61DE (-1T l HI: F.PID f)F CC�i15TFiUC:I ' C!I`I <br />'� Ilf�t::E SUfiE DF�JVEbJ(lYS ARE COhiF'LFTELl' CUREll BEFUF�E <br />�-�IV�i�Jr, �N fHFl�l <br />�� �1P;1' D(1MI1CiF T�� 11lE Clli,e nn�n .:i:n���ni r��JILL E;F.. i�t:PriTl';�ii <br />n ��'i ;P,l �'--(1C;��lili�' OF� l4L �'UEI Ti�; �,Jri(,' :, U�F'�I <br />A�� <br />Approved <br />FINALlNSPECTION �-`- � �'- - / <br />ApProved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200 Gedar Sireet <br />Everett, WA 98201 <br />Phone:259-8�10 <br />�GKNOWLEDGEA4ENT OF CONDITIONS <br />� <br />� <br />7ht� und•:asir�nud owner/applicanl hcreby agrees Io hold and save harm- <br />less ihe Cily ol Everetl Irom any and all claims lor daciages, cosfs. <br />expenses, or causes ol 2ction that may arise hecause of installation <br />and maintenance of the improvement or other rigM-ol-wa; use hereto <br />applied lor and tur�her agrees lo iemove same upon ne.�ce Irom ihe <br />City and to replace public property damaged ihereby. <br />�l ���.�'�s , /D �/b' c�d� <br />Signature of A�pplicant � Date <br />WORK AUTHORIZ[D BY 7HIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND TfiEFEAFTER IS TO <br />BE DILIGENTLY PURSUED TO CO�IPLETION. THIS PERMR MAY BF <br />CAPICELI_ED BY �fHE CITY UPON ANY STOPPAGE OF WORK ON PiiS <br />PROJECT OVER 90 UAY:.' DURATION. <br />