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i <br />�ace2%L.Y�:�' <br />ApDlicalion For <br />PUB� IC WORKS PERMIT <br />Print or Type Only <br />ulu�'K� <br />ApplicaN i•�ading Address <br />Describe ProCosed VJork <br />��� <br />' U/� aG <br />Ci�y <br />Pro�ect Atldreae Of known) �-�-� ��-�! ���� S. � <br />PUEbc Woa� Pern:n • `-' 'S 2S/3 <br />e�ec osc� . � <br />PUE�K Wo�h� Fer <br />Tol�l Fas = <br />la�eAp01 iee Putl � _ <br />B�hnce Due i ��A� <br />7,Y � -3 �i <br />d/f j/ �l2�1 �Zcf 3SS--ykr <br />ZiP Phone <br />ZiP Phone <br />�v�wsly <br />Attach four (4) copies of plan6 for pioposed work - Draw to scale and note Ihe lollowing as appficable� <br />• Propert/ LmAs • Centerllne cl slreel <br />• Outlme and tl�mensions ol ell e�isling antl • Indicate North <br />proposetl stru� t�res on the lot • Show any p�nposed grading changes <br />• Exislin{; and proposed utililies • Show measurements <br />PERMIT CONDITIONS <br />1. All calls lor inspecfion shall he made 74 hrs. in ativance - phone 2� � 88i 5. <br />2. All N,;rk shall be periormed in ectordaice wlth this permit and cun.,,, Ci1; ol [verett Design antl ConsVuction <br />Standards and Specificaticns. <br />J. Call Loration Undorground Service 4B h�s belore you dlg TOLL FREE NUMEER 1•80�•424•$b55. <br />����� ��� <br />Approved loi ConctrucUan D e <br />—_____����7� , �$� <br />FINAL INSPECTION -s���� D'nle <br />Appioved as Conslructed <br />everetl �UBLIC WOFKS DEPAHTMENT <br />� 3d00 Cetler Street <br />Evrrett, WA 98201 <br />Phona:259�8815 <br />A��KNOWLEDGEMENT OF CONDITIONS <br />W <br />� <br />� <br />� 1 <br />J <br />� <br />z <br />0 <br />ihe unAias�qne�] owner/app6canl here6y aprees to hold and save harm� <br />Icss Ihc City ol Everett from any and all claims lor tlamages. costs. <br />expr.nses, or causes ol actlon Ihal mey anse becau5e ol installalion <br />anA mainlenance of the improvement or o�her righbobway use hereto <br />applipd fo� and lurther agrees to removr same upon nolico from Ihe <br />City.R d I replace put�lic p�oper�y dam.�ged Ihereby. <br />� �/ �� <br />Date <br />ViORK AUTHORIZE� BV THIS PEFMIT MUST B[ STARTED WITHIN <br />180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAV BE <br />CANCELLED BV TNE CITY UPCN ANY STOPPAGE OF WORK ON THIS <br />PRUJECT GVER 90 DAYS DURATION. <br />