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� � <br />H <br />�Hxt~A <br />H x� <br />� H� <br />� M "�-0 <br />VJ H <br />x <br />��d <br />H^�g^ <br />Y,V \• <br />t" y � <br />i-+ H <br />N <br />C] Cy N <br />� � C+7 <br />HOy <br />i� s <br />Y M! <br />��� <br />Date h-��Z� � <br />°� qpplication For <br />PUBLIC WORKS i'�R14111T <br />Print or Type g�Y pOSTI NG ___ <br />Owner <br />Mailing <br />�C.7� <br />�%lZ �S . � <br />Fublic 1Yares Pmmit + <br />oi,�u o�a , _ 3 7 �� <br />PubLc Works °m $ <br />TO�aI Fae <br />Le55A00L FBtl Pd�J � � <br />>� <br />Bai.mceDuc $ � <br />Phone <br />Applicant Mailiny Add�ess City Zip Phone <br />Describe Proposed Work <br />Prolect Address 1it known) <br />Attach four (4) copies of plans tor proposed woik - Draw lo scale and nole Ihe iollowing as applicable: <br />• Properry Lines • Ce�terline ol streel <br />• Outline and dimensions of all existing and • Indicate North <br />proposed structures on the lot • Show any proposed grading changes <br />• Exisling and proposed utilities • Show measuremeMr. <br />� <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be performed in accordance with ihis permit and curreN City of Everett Design and Construclion <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />'�� NCk% l7OV>e �h�i� �drinGl� �',��e. 5ti/-� cri�%�� ��...a✓ cc��f�i <br />,f��^�✓'b''S �� <br />v��. <br />�.,,_��/-�/� i /<<� <br />Appro ed or Constructiof. ` Date <br />� <br />_'! �G�C� � . �I-7 3 <br />.�� <br />FINAL INSPECTION Date <br />� Approved as Consiructed <br />�PUBLIC WORKS DEPAFTIAENT <br />,V�3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259�8810 <br />GU <br />ACKNOWLEDGEMENT OF GONDITIONS <br />� <br />� <br />� <br />� <br />O <br />a <br />The undersigned owner/applicant hereby agrees to hold and save harm� <br />less Ihe City ol Everet� frcm any 2nd all claims tor damages, costs, <br />expenses. or causes ol action that may arise because of installation <br />and maintenance ot the improvement or other right-ol�way use hereto <br />�a'pplied lor and furlh�r ac�rees lo remove same upon notice Irom lhe <br />City and ro repla e uhlic property, damaged thereby. <br />. � � � L�� <br />r \ � "i <br />,,,,� , ,_�<r�/ �x��L��Y? <br />Signature of Applicant Date <br />�VORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />180 D.AYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />t;ANCELL[D BY THE CITY UPON ANY Sl OPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />F% <br />