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Date_�.jy_/��% <br />! � <br />Application For <br />PUBLIC WORKS P�RMI� <br />Frint or `ype Only <br />AppGcant <br />Descnbe Proposed Work <br />Pro�er.t Addrnss Iif knownl <br />rn <br />rna�i�-; <br />Madinp Address <br />ny <br />Zip <br />Altach lour (4) copies ol plans lor proposr.A wqrk � Draw io scale antl note the tollowing as applicable: <br />• Properry Linr.s <br />• OutGne and Jimensions ol all existing :uid <br />proposed 5trucWres on the lol <br />• Existing and proposed utilltics <br />r„ei�c wo,xs ra,Gm�� !.] _� /_7%/�� �9 _ V <br />�inv oro� . —6-7�OZOZU-�S/--._. <br />v,n,i,c wo,w. �ne C <br />tolql Fre _ _ <br />Lessl�ppl r>r Pa�d .S � <br />p,�l�ncrilun $ G �� <br />• Centeriine ol street <br />• Indic:ile Nor�h <br />• Show any proposed grading changes <br />• Show meascrements <br />rnone <br />Phone <br />PERMIT CONDITIONS <br />1. All calls fo� inspection shall 6e made 24 hrs. in advance - phore 259•8870. <br />2. All work shall be pertormed in ar,cordance with this permit and current Cily ol Everett Design and Construclion <br />Standards end Specifications. <br />3. Call Locatlon Undeiground Service 4B hrs. before you di�. TOLL FREE NUMBER 1•800•4'14-5555. <br />� V1 . . <br />-�/ /i <br />__`i,t�.!t'/Ga'c'�� C 3c� 9�9 <br />Appro� a Cons�ru/cji� �r �e/ <br />�� /� � <br />/ = '_c� %%�L' <br />FINAL INSPECTION Date <br />Approved as Consuuc�ed <br />rverelt PUPLIC YlORKS DEPARTMENT <br />� 3200 Cedar Stroet <br />Evere��, WA 99201 <br />Phone:259�8870 <br />ACKNOWLEDGEMENT OF CONDI �IONS <br />W <br />F- <br />� <br />� <br />O <br />Thu undersiyned owneqapplicant heieby agreas lo hold and save harm- <br />less the Cily ol Everetl liom any anA all claims lor Aamagea r.osts. <br />expenses, or cau,es o� aclion Ihat may arise because ol instalialion <br />and maintenance ol the improvement or other right-obway use herelo <br />appl�eC lor and turiher agrees te remove same upon notice hoin Ihe <br />City and t0 re e put C prope�ty damayed �hereby. <br />- f�is�--�— ?��� <br />Sig a!ure ol�f¢olican� �bate <br />W RK AU'HOHi2E0 BY THIS PERMIT MUST DE STARTED WITHIN <br />`BO DAYS UF OATE A[RMIT IS ISSUED AMD THEREAFTER IS TO <br />HE DILIGENTLY PURSUED TO I:OMPLETION. THIE ?ERMIT MAY E3E <br />CANCELLED BY THE CITY UPON I.NY STOPPAGE GF WORK ON'. HIS <br />FHpJECT OVFR 90 UAVS DUFATION. <br />