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t�M� <br />9H <br />C: �7 w <br />9 i-3 N <br />rm <br />hi 9 3 <br />0N <br />�H <br />[�' y <br />O H <br />n• A <br />!-1 <br />ta" H z <br />H H <br />N <br />H <br />c] t7 N <br />C C <br />F'1 r <br />z H En <br />H O In <br />Date4vo <br />Application For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />Pup12 Wa.n Permit • � c <br />end neni a �%/�i%:J <br />PohLC Werke fee • <br />T.iq ree <br />L exe APPi ree Pud • <br />e.�..�. o.. S <br />ofor <br />Maihnp Addre5s City Zip Phone <br />Norfk 1cr.,a( Ri.,k►�r l dyD��okry t't v B/v�L_ijOl�rsYr//_mod-- -- <br />Applicant Melling.ddross CdL Phone <br />Describe Proposed Work <br />Project Address tir <br />Attach four (4) comes of plans for proposed work - Draw to scale and note the following as applicable. <br />• Property Lines <br />• Cenlerhne of street <br />• Outline aed umiensions of all existing and <br />• Indicate North <br />proposed structures on the lot <br />• Show A`v proposed grading changes <br />• Existing and proposed utilities <br />• Show mr isurements <br />00 NOT WRITE BELOW THIS LINE <br />PERMIT CONDITIONS <br />I. All calls for inspection Shall be made 24 bra in 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 />Standardsend Specifications. <br />3. Call Location Underground Service 48 hra. before you dig TOLL FREE NUMBER 1.800.424.5555. <br />Approved for Construction <br />NC rt�/W f1Z M T K(-� <br />3 /4'2/9v <br />{%aLL-�1 I `-ra -s,- <br />units <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />Pvrmtl PUBLIC WORKS DEPARTMENT <br />treet <br />Ever Cedar 8201 <br />Everett, WA 98201 <br />Phone. 259 8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />-ni <br />U) <br />ca <br />O <br />z <br />O <br />U) <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett from any and all claims for damaged costs. <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or o.her right-of-way use hereto <br />applied for and further agrees to remove some upon notice from the <br />City and to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. TH;S PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WJRK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />