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�- <br />Dnte i '_�, - . <br />n„�i�ca��o� Fo� <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />i��(VY,CI�'� . � <br />Owner Madmg Address City <br />Applicant <br />Describe Prpposed Wo�k <br />Pro�ecl Address lif known� <br />Mailing Atldress <br />i :� i,�.n� . —�..!_�'--��'�-'`—'_��- <br />,.,,�:���,vo,�,�tia — --- <br />,o,:,��ea . <br />Lr:snpu� inePa�U S <br />finlanr.e �u� .S _ . _ <br />L�V Phonr� <br />.. ___ .._—_'__-_. <br />�'il�. . ... . PhOnu <br />Attach low 141 cop�es ol plans lor proposetl work - Draw to scale and nole Ihe lollowiny as apphcable <br />• Property Lines • CeNerline ol sireel <br />• Oulline and dimenslons ol all e.ishng and • Indicale North <br />proposed struCWreS an Ihe lot O Show any proposod 9intlmq r.han9es <br />• E�is�ing and p�oposed ufilihes • Show measuremenls <br />w�� <br />PERMIT CONDITIONS <br />t. All calls for inspection shall be made 24 hrs. in advance - phone 259$8�0. <br />2. All ��ork shall be peAormed in acwrdance with this permit and current Gity ol Everctt Desi9n and Construclion <br />SlandarAs and Specilications. <br />3. Call Location Undergrountl Servir.e 48 hrs. before you dig. TOLL FREE NUMBER 1-80�-424•$$$5. <br />i �c�� <br />—__...__ . _ ___ _. _ ._ _ __. _ . __ . <br />l�PV�ov��d ini Con ;Inir�ion . � �.� _ . - � Dalr. . . <br />f-INAI INSPECTION Datc <br />%�np�oved as Constructrd <br />��vrretl PUBUC WORKS DEPARTMENT <br />� 3200 Cedn� Slreet <br />Eve�ett. WA 98201 <br />Phone.259�8870 <br />i.-����� � �r��� <br />,��;��% 9—e—� <br />-, <br />� <br />O <br />� <br />� <br />� <br />a <br />Al,h^InWI EUCd fAC�JI Uf CflNUI71C�NS <br />Thr unticivc�ned uwncilaPPh�..:n� hciuh� aq�vr�, tD holtl.md sac�� h;nm� <br />Inss Ihe City of EverNll hom any ni,tl all claims br damAges. r.csl,. <br />expenses, or causes ol aClion ihal may anse bec�nse ol mslallalion <br />and mainirnanr.n ol �ho imnwvement ui nihar nGhl�of w, y ucc hr�oio <br />.�Pplu.�l I�n .ind L.u�l���i :iyines In i<�rnove s:�me uf�on noh.'.e Ironi �he� <br />C�I1 :�n�l ln i�.�d,i. �. pubh� prnu�vlY d'im:lqrA Ihrirlry <br />__ __ _ _ ... . _ . ___.._ ___.___..__. <br />vqn:Vt n �� Appiir,lnl p,lir <br />y 1HK AUTHORIZCO BY INIS PEHMIT fAUST B[ STAR7ED WITVIIN <br />180 DAVS OP DATE PERMIT IS ISSUED AND THEREAi'iER IS TO <br />BE DILIGENTLV PURSUED TQ COMPLETION THIS PERM!T MAV Bf <br />Cl�NCf�I E(1 8'� TIIF GI7V IIPON ANY STOPPAGC rJ� WORK C1fJ iH15 <br />f'RlU( (�.i ll`JI fi'�� DA1"1 DURh�fl(1N <br />