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Date�/.�S <br />Ap?liCatiDn For <br />PU[3LIC WORKS <br />Print or Type Oniy"! ��STING `��� � <br />�,. <br />r. <br />PERMIT <br /><I <br />CJ <br />� f'� <br />�j <br />T <br />adiny A�dress <br />rna��lmc, Address <br />o,e� � wo,wt P�.m,� 95 080 � <br />61�19 peo� + __ ��� _ <br />Putilic W.rks Fec <br />Totnl Fep S <br />Lt554pU� FeePa�.� 5 <br />� c; n� i:�, r:-� _—'l5�— <br />i;, �„ �, ,;�, o,�.,��., ���, s 83-- <br />.r `D I' �/(/ / n ? <br />N � NI p ,� ��ll��� �2LT�/) iOJ/ <br />� f m �t-�.2 v�n. `f/ <br />0 <br />,Cijyc �5 b�r. � 7_iP Phani, — <br />c� u ::i r :s. �a <br />_� r_ __� r i-- �:: <br />; : �.�..� c., � � <br />9�2� __ 2Sy- S7BS <br />City ?iP Phonn _'—.—__ <br />Describe Proposed Work , L�L %�LOh ._ �Q __�LL��i- q __�" JJ�vi= <br />.J— T'.--_`_ <br />.S'v�-�ou���e2, -- -------- --- <br />--- ----- - ---- ---- ----- <br />ProjectAddress(ifknown! _��z2___Lp�P�- ���-�'0�� ��_.� __ <br />Attach tour (41 coPies ef plans fa PioP��ed wurn � Drav: to aoii;..i:�..� ��i:te ihe !oiluwmy as apUlir,able: <br />• Pronerty Lines <br />• Outline and dimensions ol all exishng and <br />proposed structures on the lo� <br />• Exis�ing and propOsed utili�ies <br />• Genterline ot sireet <br />O Icdir.a�e Nor�h <br />• 5hov: ar�y r.roposed qrading ;,hanges <br />• Show measure.nents <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•881 O. <br />2. All work shall be perfurmed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-$00-424-5555. <br />�• <br />J�. <br />i9/�PLicy.✓T �//Usr �PErii•s�l T.s�E' Fii�� <br />i�yD,��„f Loc4�:��s Gvi� fi5e �'i�e il7ars/,.c�Ls <br />O/7`�GG �¢r .f,G Pf�. COn�/ foh . <br />/J � e� �( Ty Sfrn_ e7`s C� �e�'C/� R� q�� [(ho P_.i <br />' __ __ _I <br />�� �� /� ; <br />Approved for C ;f�uction � �� ; <br />� Date i <br />�--_ �=C�-� �-C-�� � <br />FINAL INSFECTION Date I <br />Approved as Constructed � <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA g8201 <br />Phone:259�8870 <br />ACKNOWLEDGLMENT OF CONDITIONS <br />�1 <br />s <br />� <br />� <br />� <br />Y/ <br />� <br />a <br />Thu under�ianed owner/apphcant hereby agrees to hold and saco hann� <br />I�a,s the City of Everelt from any and 211 claims lor darnages. r,osts. <br />expenses or causes of action that may aris^ hecause ol installatiun <br />and mamtenancc o! the improvement or other right-oFway usa hereto <br />appnrd ler and furthe� aqrees to remove samr upon notice �iom the <br />C��!y and to replaca oubhc p�onerty damagr�d thereby. <br />W-�- .���--� 6-s-gs <br />S�gnalure of AnPhcan! Datc <br />VJORK AUTHCRIZE� BY THIS PERMIT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLI' PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED B'f THE CITY UPON ANY STOPPAGE OF WORK ON 1 HIS <br />PRO.IEGT OVEF 90 DAVS DURATION. <br />