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aHTn <br />H Im <br />r< L7 <br />H `i1 <br />N N <br />Z <br />TV <br />O <br />F4 • Ci <br />>X>H <br />rHH <br />rA <br />N <br />t� C N <br />''l myy <br />H O rr0A <br />F <br />DAtO M/ K1 Peak Pubnc Worry Pefmd <br />1, 0"N Dept • .qay <br />nm-,Iicatinn For <br />PUBLIC WORKS PERMIT Put UteriFeeFee <br />Less APPI Fee Paid i <br />narance 0.0 a <br />Print or Type Only <br />Owns Mailing Address City Zip Phone <br />Applicant //�� /Mailing Address City Zip Phone <br />Describe Proposed Work &UA,_ NM bi--- <br />Project Address III known) �C'c�% Z�v « Sj` -- <br />Attach lour 14) copies of plans for proposed work - Draw to scale and note the following as applicable <br />• Property Lines <br />• Conlerline of street <br />• Outline and dimensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show any proposed grading changes <br />• Existing and proposed utilities <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All tags for inspection shall be made 24 lirain advance - phone 259.8810. <br />2. All work shall be performed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications <br />3. Call Location Underground Service 48 hrs before you dig TOLL FREE NUMBER 1.800.424.5555. <br />Tl�'/1�ic• u.kn(1�'+-/�''`� /�6�` �n f-crr�tro�' <br />�D-o>`+-d- •�e�L 3-¢ex.C.¢trl+i 9ct-low Guu�",v 71Gc✓-- <br />Approved for Con, Iruction Date <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />l <br />rett PUBLIC WORKS DEPARTMENT <br />E200 verett A 8201 <br />treet <br />Everett WA 98201 <br />Phone: 259.8810 <br />LU <br />/mow, <br />O <br />r.R <br />Ilam <br />O <br />/I <br />L[ce✓ o Ae u��1n.Ftw! Aii ral <br />oe4- o� <br />2.2z% <br />11�� <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm. <br />less the City of Everett from any and all claims for damages. costs. <br />expenses, or causes of action that may arise because of Installation <br />and maintenance of the improvement or other right-ol-way use hereto <br />applied for and further agrees to remove same upon notice from the <br />City and to replace pol-' property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />160 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAY, DURATION. <br />01 <br />