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/ <br />Date S F'� �� <br />Apphcation For <br />PUBLIC V�/ORKS PERMIT <br />.� <br />Print or Tyoe Only <br />Public Wmxe Permil � �� — ��� <br />e�aa oeu�.. -- — - - <br />Po�oc Worw� Fee <br />Tote1 Fee s — <br />LeseApo�FeaPaitl S _ <br />BelancaDua S �OOC <br />,Pcx�E,e: /��e.�.eE �oic'� acv�,e��/ B�vo. E✓E.P�ir y9zo3 .�s3- z9Bo <br />Owner Mailing Atldress Ci:y 7ip Phone <br />s�9i7>E <br />Applicent Idailing Address Cil;� Zip Phone <br />Describe Pioposed Work CC�/ST.E�e••cY S��Eu/�9•t�C fiti� I�.Pi✓6�Jr91/ _ l�CJ'O <br />i <br />�'E��o��6 P�i'.PT �f E.ris'Ti�uG 1�.PivEG/i91/ <br />PrOject Addiess (il known) <br />Attach four (4) copies of Ulans for proposed work - Draw lo sr.ale and note the lollowing 3s applicabl=: <br />• Property Lines • Centerline of street <br />• Outline and dimensions cf all existing and • Indicate North <br />proposed structures on the lot • Show any proposed qrading changes <br />• ExiSting and propo5ed ulilities • Show measurements <br />PEFMI7CONDITIONS <br />1. All calls lor inspection shall be made 24 hrs. in advance - phor5c"259-8815.- _. __ _ <br />2. All work sl�all be performed in accordance with this permit and wrrent City ol Everelt Design and ConstrvcHon -__ <br />Standa�ds ond Specificvtions. <br />3. Call Location Underground Sorvice 48 hrs. belore ��ou dig. TOLL FREE NUMBER 1•S00•424•5555. <br />tr !�l/o.P�F- /s T� BE IJcr.rlE fE� SHc+er��,9T /ZoZ-3-86 <br />�t9Cii,CE/l�EN%-f , <br />.S .�%[l 6!/O.CF' /•�/ TiYE' i�UB�/L �DLcJ /S To BE' Doit/E <br />,8f/ fi C/i �c,�,.6'�cs��jNDE1J COit/T.e.9cTo.0 [✓iTi/ '9 _. <br />G'/Tf/ O� c�!/.FP_ �.�i% BUS/NESY' G/fEN�E , <br />�p. �TiTi.c�ivElJill% Tt� �E �O,U-SY.Q6'CTCO �'.t' L/Tt� Of <br />� �, <br />�r��.eE ,r sr.v��vs��os � .�a7� .�o � .�os , <br />-1,. 3' �.�. � ;�-�,�,. � <br />S, �,P z -� �C,�•) � - <br />I� <br />FINAL RtlSPECTION � <br />Approved as Conslrur.led <br />everett 1'UBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Evere�t, WA 98201 <br />Phone:259�8815 <br />Date <br />W <br />H <br />VI <br />i <br />Vi <br />O <br />a <br />h.�,,� DG� �,�. ��-y�a(�'Q\�' <br />��ti�� AC NO LE T OZV�yfC}�6,r�pI D�IT�ONS �� <br />The undersigned �ner applican�t h�e�reby ag- reeS'76hold and save harm• <br />less Ihe City of Everett irom any and all claims lor damages, costs, <br />expenses, or causes ot action ih�t may arise because of Inslallation <br />and maintenance ol Ihe improvem>nt or other right�obway use hereto <br />applied for and lurther agrees lo remove sene upon notice Irom the <br />Cily and to replace public property damaged Ihereby. <br />/ �F i .C�/ n'7 (l6 <br />Signalure of ApPlicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF OATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLEU BY THE CITY UPON .1NY STOPPAGF OF WORK OM THIS <br />PROJEGT OVER 90 DAYS DURATION. <br />