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�3r� <br />� �y� <br />"7 y <br />9H� <br />� <br />IyC�C� <br />H xl <br />� H � <br />m� <br />yZ � <br />�H� <br />OH <br />�/��g <br />y� V CC] <br />t+ y 2 <br />�, y <br />� <br />lj t7 y <br />P7�t+f <br />HO� <br />/ <br />i � �;. <br />A ' <br />s ,�. <br />Date��(� <br />qpplication For <br />PUBLIC W(3RK�► P'ERMI�' <br />Print or Type Only <br />� PuC4c Worha Pormi�l 1• /— /�/1? <br />einq oeni • �L' 2�/GrL.c�J - <br />PueLcwornslm 5 <br />Total Pcc <br />LessAU01 PeePorJ § <br />�alanca uun � <br />�J L(.c-4 /J ✓' <br />Applicanl Mailing Address City Lp Phoue <br />n��,�,� , <br />Descrbe Proposed Work �'7-F--/-� � �� ��� 7 �� <br />Frojn,c! qdAress �il known) <br />Altach (our (41 copies ol plans lor proposed work - Draw <br />• Property Lines <br />A Outline and dimens�ons of all =xisting and <br />proposed siruUures on the lot <br />e ExisUn9 and proposed utilities <br />scale and note the followin9 a� apphcable�. <br />I:I� <br />• Centerline ol street <br />• Indicnte North <br />• Show any proposed grading changes <br />• Shov: measurements <br />PEP,MITC7NDITIOIJS <br />I.! �I calls ic� inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. Ail work a6a�l be pertormed in accordance with this permit and current City of Everelt Design and Coristrc-lion <br />Star.dard� acd Specilications. <br />3. Call Loca�1.•n Underground Service 48 hrs. bebre you dig. TOLL FREE NUMBER 1•B00•424-5555. <br />/ L/G�-CGC 6t/c�/T3- fCl�ivr+�' �c.�b/ /c.['y.i� <br />1 <br />Appwved lor <br />Da�e <br />FINAL INSPECTION Date <br />Approved as Comtructed <br />evcirlt F�BLICWORKSDEPARTMENT <br />� 3200 Cedar Sireet <br />Everett, WA 9P201 <br />Phonr 25�J-68!� <br />�' J" `" _ � az.-��z. <br />�/—i S�-%C <br />ACKNOVJLEDGEMENT OF CONDITIONS <br />� <br />� <br />� <br />The undersigneJ Owneqapplicant hereby a9rees to hold and save hartn- <br />less the Cily uf Evorett irom any and all claims for damages. cn,ys, <br />eapenses. or caases of action Ihat may arise because ol installation <br />and maintena�ice of the improvement or other right�ol-way use he; •�o <br />applied lor and further ayrees to remove same upon nolice Irom the <br />Cily and to rrplace public proper�y damaged lhereby. <br />Signalure of Applicant L1i1O <br />WORK AUTHURIZED CiY THIS PERMIT MUST 8E STAFIED WITHIN <br />180 �AYS OF UATE PER411T IS 15SU[D AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUHU TO COMPLETION. THIS PcRMIT MAY BE <br />CANCELLED BY THE qT'! UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 UAYS UURATION. <br />