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[�'� [ri1 �j <br />��H <br />fa Hx Co <br />HxH <br />fC C] <br />V W Q <br />� U. F� <br />[�1 O � <br />H C7 <br />OH <br />��S <br />�.. � <br />�H� <br />x <br />HH <br />8 �' <br />H <br />n Cd � <br />C?Irt�1 <br />H [/� <br />HOU� <br />{�� <br />Date1LLL C/ ' <br />/ / �i <br />PUB�LIC <br />Print or Type Only�z <br />ra <br />o� <br />Appliwtion For <br />_i"o Post.��:, <br />� • llc • ; � <br />WORK:S PEF�MIT <br />Ci <br />II'1 C'- <br />� :i�, r:', ;._ <br />.,: ,: <br />✓" <br />Puub: WOMs PMmlt n <br />Li-2✓ � <br />Eiaa oen�.• j � �— <br />FuGlicWo�kS�ec � <br />ioiai r�e <br />�e5s aoo�. Fec Fina 5 — <br />lJ�� <br />BdIdnCC �Ile S �`J <br />C('._' .i',%�'-`/n-ODO-//- 3>� <br />ProjedAddresslif known) _ ��S r/-. ���A✓f!?7� �/� ���'�Y! / <br />Attach lou� (4) cnpies ol plans lor pmposed work � Draw to scale and note Ihe'ollowing as applicable: <br />O '�operty Lines <br />O Ou�line and diroensions of all ezisting and <br />proposed sVuctures on the lot <br />C� fxisting antl proposed u�ilities <br />• Genterline of street <br />• InCicate Norih <br />• Show any proposed 9radin9 changes <br />e Show measure�nenls <br />PEfi�nlT CONDITIONS <br />L All calls for inspection shall be madz 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pedormed in accordance with ihis permit and current Ciry cf Everett Uesign and Consiruction <br />StanAards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you d�q. TOLL FREE NUMBER 1•fS00•424-5555. <br />� L-CC.C-�� -�'Z !v <br />U <br />/Jaz1�-�� ��"--f <br />��.vx� nf lC.7r t�- <br />,� -l-�. ^!«.� G,�r'Y,�. .�<'.�' ��/<.�o��.. <br />., �. � �- � . _ <br />�L�C�. , '�!' 1 _ ' C�ii«.c �., �����c ,��✓ <br />. „ <br />i n <br />j ' � �r <br />,�� ) °�c — <br />-� f <br />�_ G�./c, %yi �"f-= G/�i i <br />ApprOved for Colrs�uctiOn Dale <br />( �C�e il. / . � ' �� ' � . <br />� !'. ���'/d/Q <br />FINAL INSPECTION � • � Da�e <br />AnProved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 3200CedarStreet <br />Everetl, WA 98201 <br />Phone:259�8810 <br />ACKNCIWLEDGEMENT OP CONDITIONS <br />�� <br />The undersigned ownea/applicant hereby agrees to hold and save harm� <br />less ihe City uf Everett irom any and all claims for damac�es. costs, <br />ezpenses. o� causes of action Ihat rtay arise 6ecause ol inslallation <br />and mainienante of �he improvement or other ric�hFOFw�; use here�o <br />applied lo and further a rees to rertove same upon notice from the <br />Ci�y and I replace pul lic properry da nnged ihereby. <br />\' �' �-' � \ ��,�, � � � �� � �� U <br />Sryna�ure o� Applicant Date <br />WORK AUTHORIZED BY THIS PEF NIT MUST BE STARTED W�THIN <br />1B0 DAYS OF DATE PERMITISIiSUED AND THEREAFTER �S TO <br />BE DILIGENTLY PURSUED TO CGM1���'_ETION. THIS PERMIT MAY BE <br />CANCELLED BY THE GTY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 Df.YS DURATION <br />