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� � � <br /> o � x <br /> C, H <br /> 9 �V� <br /> y <br /> % <br /> '""� �/�yR �� /�� <br /> � y � Date�..L:.�L/ V� PuEI�cYfoikaPer ' �J—� <br /> � y H Applicatian For d�ee�oco�-• � - <br /> � o� PUBLIC WORKS PCRMIT PULTotalF;a"° 5 <br /> H C �ess noo�Fea aa�d 5 <br /> �� g a,�a��,o�, 5 2�°� — <br /> �� � Print or Ty��e Only <br /> � y� � � ,3�'� /�IU �Di� 8177 � a�- 7 <br /> H H - - — <br /> t7 V� H v/ er � Mailing Adtlress City Zlp Phone <br /> O <br /> C� C�n <br /> � t� � �l'I I"��� <br /> y y Applicant Mailing Adcress City Lp Phone <br /> HO(n c /� /1�/� <br /> Describe Proposed Work �-�� � 7�I� ��� �( � � l�-���� <br /> Prolecl Add��•".(if known) /7/�— Ed��oo,c L.f/, � <br /> Altach tour(4)copies ot plans for proposed wnrk-Draw to scale antl note Ihe lollowing as applicable: � <br />� • properry Lines • Centedine of street /^ <br /> • Outline and dimensions ol all exisling and • Intlicate Nor�h V� <br />� proposed sirucNms on the lot • Show any propcsed gratlin�changes <br /> • Ezisting and proDosed utililies • Show measurements wA <br /> W <br /> f�� DO NOT WRITE BELOW THIS LINE O <br /> 1 ' PERMIT CONDITIONS <br /> � 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�his permit and turrent City ot Everetl Desi9n and Consiruction � I <br /> '�1 Standards and Specilications � <br /> 3.Call Location Underground Service 4B hrs.before you dig.TOL�.FREE��UMBER 1-800•424•5555. � <br /> 1—� 5�,�, B�� a.t` 1 <br /> 5! �v;��' ��t� �,�.. � ��,t� O `� <br /> i; �o��G c�r o�.Q''o� �1l�%f /,J���C�dQ:v wmr,�o- ���vz <br /> _ �o-..e .Ge��C,n.�.L.�/ �ify •`aoz,�. � <br /> '-1 ,S ,�.u.v,�a.¢s-«�t s.��s.a.ec�� �n� ,00��" -��� � <br /> � ,� �:� . O <br /> _ �� it/OTE. ��l/DlE.2 s���,�� ���T,�,� ,S � �. �� a <br /> � � ��,. �i�u/��3`a��� 1, No7` �� s��zyo�z�'�`li ���u �- <br /> �� -G�LCI�� �N �IlY�Gf �Rw�/ o�C�-GGCt� - � <br /> '_ ACKNOWLE�GEMENT OF CONDITIONS <br /> ' The untlersi�ned owner/applicant hereby agree�to hold and save harm- <br /> � less the Cily ol Everett Irom any and all claims for damac�es, costs, <br /> / / /// pO ezpenses, or causes ol action Ihat may arise 6ecause of installa�ion <br /> ����Ob�t. (O/ � T/OC7 and maintenance of the imProvement or other right-obwaY use hereto <br /> applied lor and luriher agrees to remove same upon notice from �he <br /> Approved for Construction �� �� City and�o replace public property damaged ihereby. <br /> iC / C�^^� �� , � {� <br /> $ -1-`lJ �( "1 ! � ��//il�� <br /> FINAL INSPECTION Date /G� <br /> Approved as Constructed Signature oi A Gcant �Date <br /> WORK AUTHORIZ[U BY THIS PERMIT MUST BE STARTED WITHIN <br /> everMt PUBLICWORKSDEPARTMENT 180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> � 3200CetlarStreet 8E DILIG[NTLY PURSUED TO COMPLETION.iHIS PERMIT MAY BE <br /> Everelt,W�9820t CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> Phonc 259�8810 PROJECT OVER 90 DAYS DURATION. <br />