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.� <br />)�} � <br />Date_��1 � 1 <br />APpli�tlqn f-o� <br />PUBLIC W�KS PERMIT <br />I. <br />C <br />G <br />Print or Type Only � �O "' � `� <br />[� [� P �t <br />Ill O� O 3' r) .�+ <br />.. •a� � v� r-? m <br />MNC.:10�0 <br />�✓�/1 _.,, I ni `—i I Qi `-a6-�-i 7�� m ��- <br />Z�p <br />Describe Proposed Work <br />Project Address 111 kncwnl •� �c c. � <br />,,�,�„�.�.,,,..� `3p �<"3� <br />E,�,,� o�.�� . ����,'��� <br />I��iUli�: N'OIYf {I'C � <br />1�IPIfP! `S <br />Lev� ^nc� Fee P.�O $ � <br />n,,�a,��o�� S � ��� ._ <br />C1.+/rLc�ly-3 D.�'iYNq� F <br />ff£ `n�C' Eti'Ti.cl SiT[-". <br />T U_ �IoFS-14�'� � <br />% ��58 3'.�1�7 <br />CL'1C�A �Gt,�' �.'--��� <br />Attach lour 14) copies ol plans lor pwposed work � Oraw to scaie and note the tollowiny as aaplicable: <br />• Property Lines • Centerllne ol street <br />• Oufline and dimenslons ol all existing and • Indlcate Norih <br />pwposed struc�ures on the lot • Show any proposed gratl�ny chanoes <br />• Exisllny and proposed uli:ities • Show measurements <br />� '', PERMITCONDITIONS <br />I 1. All calls for inspection shall be made 24 hrs. in advance- phone 259•8810. <br />���. 2. All work shall be pedormed in accordance with this permit and current City ol Everett Des�gn and Gonsiruclion <br />�� � Standards and Specilications. <br />� 3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� ' . <br />� �� � � �� . <br />� �C'L -Z�. .CCi � CYC'JZC �Z��.S' f!<_C� ��C,�t. ����1r.1.,� _/r'-Zct' `J�Y <br />'_ <br />�� <br />�;:.9n' <br />l.�.G �c�a S'.�G A9 <br />Approved lor onstruption Date <br />.�'�i <br />�'� /< —. �/ %d%`_ <br />FINAL INSPECTION Dale <br />Approved as Constructed <br />eveielt PUBLICWORKSDEPARTMENT <br />� 3200 Cetlar Slreet <br />Everelt WA 9920f <br />Phone: 259�8810 <br />.�':it3��, <br />W <br />H <br />_ / <br />� <br />O <br />�w <br />_ I <br />O <br />a <br />ACKNOWLE�GEMENT OF CONDITIONS <br />The undersigned owneqapplican� hereby agrees fo hold and 5ave harm� <br />less Ihe Ci�y ol Everet� irom any and all claims for damages. costs. <br />expenses, or Causes of nclion ihal may afise beCauSe ol installalion <br />and maintenance of Ihe improvemenl or ofher iighl�of�way use herelo <br />applicd br and further agrees to remove same upon notice irom inc <br />City and to repl;�e public property damaged Ihereby_ <br />V <br />Signalure ol pplic nt Date <br />WORK AUTHORIZED BY PERMIT MUST BE STARTED INITHIN <br />180 DAYS OF DATE P[ ITISISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSU TO COMPL[TION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />( ', <br />, ...�., <br />,; <br />