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Date L - I `I -� j <br />Applice�ion For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />� <br />Owner <br />ng Atldress <br />Pueiic Woiee Permn • 0 3 � � <br />eiao o�o� • -- <br />cunec Woiwe Fee � a p• UD <br />Toteifaa <br />Lea� �p0� Poe P��� � ^, <br />Beiencn [1ue 6 � �' � � <br />b33 <br />Phone <br />Describe Proposed Work \ <br />��1�1�1 /(1 � V N�IJ T/��6Y\P � . ���C.) <br />� 30� � c��T <br />— <br />Pro�ec� Addreee (i� known) __1��1.��Id��%�a�� �D � /i2. � • <br />Atlech lour (4) coples ol plans lor proposed work - Draw lo scele end nole the lollowing as nppli��able� <br />• Property Lines <br />• Ou�lina nnA dimansions ol ell arisling end <br />propused etructures on ihe lot <br />• Existing end proposed utllitias <br />• Centerline ol slreet <br />• Indicete Nor�h <br />• Show eny proposed g�ading changes <br />• Show measwements <br />PERMIT CONDITIONS <br />1. All cell3 �or Inspection shall be mede 24 hra. In eAvance - phone 2b9•881 5. <br />2. All work ehell be performed In eccordance with Ihis permll end current Ciry ol Everett Design end Canstruction <br />Standerds end Spacllicellons <br />3. Cnll Locetlon Urderg�ound Service 48 hrs. belore ycu dig. TOLL FREE NUMBER 1•800•424•55n55. <br />/� �ne�all �a.n�l/s�.�i..�\ across �-++��a�e o� new Pt�v.�1 A,lt.` <br />• J I <br />0.9 S.�now.. K..-. � �Ol"l S S��NF.�NI <br />�( c1rw�.. ��v ¢T�1'4-�.. • s - s'.�� C- �. <br />5', ..e�.,. Pave .ve� ......tiF J <br />n f ' �e.� er <br />(�. �.. � ca.P - e CF no C x� e� i.�( <br />Y�f,...�y ��te�wl�t�Y 7�dt � 7C wc� 1 p �.Y ♦ 1 . <br />�� YhNI� bC ,IH111'G r 1fwr V� JCoai�?rin1� <br />ex�t�i.�y bcoll. v <br />J <br />FINAL INSPEGTION ' \ <br />qpproved as Conelructad <br />� <br />r�vrrrll PUBVC WORKSC <br />� 3200 Cedar Slreet <br />Fve�elt. WA 9820+ <br />Phonn 2fi9-B015 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />w <br />H <br />� <br />� <br />� <br />O <br />� <br />N <br />O <br />a <br />7he unclr^s�gned owner/applicent heraby egrees to hold end seve harm- <br />less u�e GIy ol Everetl Irom eny end all clelme lor demages, cosls, <br />e.per�ses, or ce��sPs ot ection ihet mey arise beceuse ol Inetalletion <br />anA meintenance of iho improvamenl or othar righPol�wey use hereto <br />npphed lor and luriher ng�ee6 lo remove seme upon notice Irom the <br />Ciry end lo replp�e publlc properry dameqed thereby. <br />� '1 <br />� �.,�� 1� ��,-� _ <br />l. - <br />I�DI[il <br />WOR AI;THORI2ED BV TNIS PEPMII� MUST BE SiARTED WITViIN <br />180� AVS OF DATE PERMIT IS ISSUED AND TNERFAFTER IS iP <br />BE DILIGENTLY PURSUED TO COMPLETION THIS PF.�MIT MAV BF <br />CANCELLFD BY iHE GTV UPON ANV STOPPAGF OF WORK ON THIS <br />PROJF( T OVER 90 D�YS DUfiA710N <br />