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r• Applicalion For <br />O <br />PUBLIC WORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 (425) 257.8810 <br />P,_6c�rlc�- <br />TYPE OR PRINT ONLY <br />1&1'41. c Ulf, rA,wIAS Ilv 7q'ytSyL S1 <br />Date <br />Public Works Permit N Od <br />Building Permit N <br />OO <br />Public Works Fee $ <br />Owr a Mailing Address City Zip Phone <br />Appiican: Mailing Address City Zip Phone <br />Describe Proposed Work LrU <br />on kcJ s CIQ QI koaslfe <br />PROJECT ADDRESS (it known) <br />Attach lour (4) copies plans for proposed work - Draw to scale and note the following it applicable. <br />• Property Lines • Outline and dimensions of all existing and proposed structures on the lot • Existing and proposed utilities <br />• Cnnterane of street • Indicate North • Show any proposed grading changes • Show measurements <br />DO NOT WRITE BELOW THIS L,NE <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall be made 24 hours in advance - phone (425) 257-8810 <br />2. All work shall be performed ill accordance with this permit and current City of Everett Design and <br />Construction Standards and Specifications. . <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424.5555. <br />kw n/// —5�✓'c�'7'rs ,t6zCa/, u/l:Lc �or:l emirs woPiE' <br />5 %figs o/rivc/L �s' �oY <br />/ a^y jyrUJT GCr'IreO /nUhC �in%) �u77. TrOn, 7Nn <br />yyL)pr�}'s��"O/1f�.ya. �iC O1SdC/' G <br />kt.zAppp iOfY a e <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />/ n •6e a.-, fh:s <br />� noatN Ca- <br />�llf,us7` 60 ohel 4Jo7nninf _� <br />NOT i i0 w/TNoJ% <br />f,5r,!6WAr0A0 OF OWNEa OF <br />X <br />z <br />0 <br />`f^ <br />M / <br />0 <br />am <br />--'— ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs, expenses, or <br />causes of action that may arise because of Installation and maintenance of the <br />improv lent or other right of -way use hereto applied for and further agrees to <br />remgv� Same upon notiFe from tt)p City and t9fmplace public property dam. <br />WORK AUTHORIZED BY THIS PERMn MUST BE STARTED WITHIN 180 DAY i OPVATE PERMIT IS ISSUED AND THEREAFTER IS TO BE DILIGENTLY PURSUED TO <br />OOMPLETION. THIS PERMIT MAY BE CANCELLED BY THE CRY UPON Ally STOPPAGE OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />