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Date "� � �� ;> <br />Application For <br />PUBLIC WORKS P�RN11T <br />Print or Type Only <br />ei <br />APPlicant <br />Pdailing Address <br />.,,� ,_ <br />PubLc NurFs P i' t__ ��� ��� '� <br />Y �_ <br />P.I 4J D�pl. a �1 L.i� _— <br />P� o�ks Fe��� <br />TolalFco $. <br />Le;s Hnp�� Fee Pai� S <br />o,m��� o�� ffi �,7�1� <br />S ��a�� <br />Zip <br />City Zip <br />Describe Proposed Work � '���� �_ti J C71 (� / ..� � .� ��( �� 1'� C� <br />Projecl Address (if known) ��/ �7� — � �h <br />/, ,_ <br />CG.`�� -:��!� � <br />YhOne <br />Attach lour 14) copies of plans lor proposed viork � Draw fo scale and note the following as applicable: <br />• Property Lines • Centerline of street <br />• Outline and dimensions ot all existing and • Indicr:te North <br />ry000sed structures on Ihe lot • Show any proposetl grading changes <br />• Exi�Iina and proposed utilities • Show measurements <br />���s <br />' DO NOT WRITE BELOW THIS LINE <br />��,1.�W PERMITCONDITIONS <br />1. �;� calls (e.r inspection shall be made 24 hrs. in advance - phone 259•8810. <br />1. All work shall be performed in accordance with this .iermit and current City of Everett Uesic�n and Construction <br />Star�dards and Specifications. <br />3. CaU Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424-5555. <br />q ind�' Ghi�l�lr�c I. i'I- UI �hl':� IU- .. .I __. '..._. <br />1 � '��{F ' UL-:I_?:f U� ':i:� [ilU:'E� isnt, <br />S,USE PUL'�LTC LIZ('�1NF1GL- �1t=1F_f' t�S 1='f'0'JT_Y)ET:� I"0;": <br />6. flhdY I_pT Gfi(-1TiE Cf-;('d Ii.iCS I'1U:�'i I::G ; iP'f'IiO�,'f=v i1Y , <br />F'UGLIG 1t�01�lI':3 It�l���'1=GTOR, <br />7.I:EEF' CIl `( fI �1:FEl::; (.',1..;:i"-�N A'7 Fii._L TIi•IF..'�. <br />_� !' 1� 7ALL WA'. �=F � L �_� f'';1-: r:ir �^. T T..0 Ef?l. �_. _. _� I <br />�� I_ SUI�E U,,: '� �s.' '; � �' . . ' i � ' <br />1:'J I:I'It'; 0;•; � <br />/ � <br />` �� �� <br />i 2�... 'cr— � .� .���'.'7 <br />Approved lor onsfruction Dat^ <br />FINAL INSPECTION <br />Approved as Consirur_�ed <br />e�veret[ PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everet�, WA 98201 <br />Phonc: 259�f3910 <br />one <br />na<rdowi_eocerseNr or coNoinoNs <br />7hc undersi��ned oivn�u/apphean! heraby a�rees to hatl and save harrn- <br />less Ihe City of Everelt from any and all daims loi daaia�es, costs. <br />expenses, or causes of action Ihat may arise because o1 inslallation <br />and maintenance of the improv^ment or othei righrol-�.vay use hcreto <br />applied for and luriher agrees to remove same e;��� notice from �he <br />City and to replace oiblic property damaged thereby. <br />�/ � - r �j , <br />o:��<� �d/ C=l, �%'1 `%lG'c.c�-,.� '�`! �'�. <br />Signature of Applican� ' Oate <br />WORK AUTIiORIZED BY THIS PERMIT MUST BE STARTED WITHI�J <br />180 DAYS OF DP,Tt PER�tf( IS ISSUED AND THEAEAFTER IS TO <br />BE DILIGGNTLY PURSUED �O COMPLETION. THIS PERMIT MAY B[ <br />CANCELLED 3Y THE CITY JPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OV6R 90 DA�:i DURATION. <br />