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Date�� <br />. . � ' qpplication For <br />PU�LIC �JVORKS F�RMIT <br />' i,�,. <br />Print or Type On�y <br />, ._ -{,,� Y' , <br />Address <br />�vviP- qs G��1L <br />Applicant Mailing Ar:dress <br />Y <br />Describe Proposed Work <br />Ciry <br />Pu�hCNo�65 Pcimu e G`' / I � -- <br />3�8'"3 <br />Biae. oeo�. • . . <br />Pu[JicWorksFae $ �p C] J _ <br />Tolal Foa <br />�� <br />Lass ApPt Feo Peia wR — <br />$ ]'p. (7 �.� <br />dalance Duo <br />�EVL�tI��'� <br />l3ut � d. �.,-s <br />35.3-7im � <br />Phone <br />Project Address (it known) - < < �" -' - <br />Attach lour (4� copies of plans for proposed work - Draw to scale and note � CQ°�1erl;ne of sheet a�lc-: <br />• Property Lines • Indicz�e Norih <br />0 Ou�line and dimensions of all exisliny and � Show any pro;,osed grading chan9es <br />proposed structures on the lot � Shovi mea���rements <br />• Existing and proposed utililies _ _— <br />Phone <br />PERMIT CGNDITIONS <br />1. Ail calls for inspecticn shull be made 24 hrs. in advance - pho�,ie 259-881 5. <br />2. All work shall be performed in accordance wiih this permit and current Ciry ot Everert Desi9n and Construction <br />Standards and Specifications. <br />3 Call Location Underground Service 4A nrs. �efore yoo dig. iOLL FREE NUMBER 1-800•424•555 . <br />j i i c r-> S <br />- � j -/j,� �c��C2✓ � ' �) <br />� Date <br />A p p ro—v e d�C o n s L• u c h o n <br />��� <��� —;-�s� <br />� ate <br />FINAL INSPECTION <br />Approved as Consiructed <br />evere[t PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />[veretl, WA 98207 <br />Phone:'S9�9815 <br />ACKNOVJLcDGE�dENT UF CONDIIIONS <br />The undersigned owner/anPlicant hereby a9rees lo hold �nd save harm- <br />less the City of Everett uom any and all claims �or damagas, costs, <br />expenses, or causes oi aclion that may arise because of installation <br />appl ed1foe and fa th`e,'egrees to remrne `ame up'on nolicesfromrlhe <br />City and !o repla�e public property damaged thereby. <br />,/ �� ' �� y/�� /��/ <br />�(� � 1 ����— ��� � <br />Da�e <br />Signature ol Applicanl <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED W�TIiIN <br />780 DAYS OF DATE PERMIT IS ISSUED AND THEFEAFTER IS TO <br />BE DILIGEN?LY PURSUED TO COMPLETIOPL THIS PERPAI7 MAY BF <br />CANCELLED BYTHE CITY UPON ANY STOPPAG[ OF'J+GRK Old?IiIS <br />PROJECf OVER 50 DAYS DURAT�GPI. <br />-� r <br />� � <br />rf; � <br />G� <br />~ ( <br />G: <br />