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��� <br />o�x <br />C., H <br />9HW <br />y� <br />Oxo <br />�f~pH <br />x <br />��e <br />��g <br />�] V �] <br />zy��NH <br />y <br />O � ti <br />�Hf/� <br />HOfa <br />Date��'�I � <br />PUBLIC <br />Print or Type Only <br />Applicant <br />App�alion For <br />W(�RKS PERIQIlIT <br />0 <br />O <br />� o���g� <br />m ti�om,u� <br />M �O [� Op� M .�+ <br />IlI +�+N�O N �P <br />�L�c°q°��i' �� <br />�taTN'�,�.'"G]�}"i � N Y <br />0 0 1— 2? f-- 1— W <br />� oa��a.a.x <br />o, aoa ooc� <br />tdailiny Atldress <br />Descnbe Proposed Work � ��� � � � � � <br />Project Atltlress (if knownl <br />'��'/02 <br />Put�Lc V�oas P�r%mJ�-`y��� <br />6i�g.DuOt . �./—L— � <br />PUL�mWarYSFee S— /�j(�M� <br />toia� vee _ 1--f—� = <br />�ess Anoi Fert Pa�u S__�e <br />o,�:,.,« o�� s j 99 2� — <br />Cily <br />o21�/r:--k'R! �7 <br />Gty Zip Phor.e <br />Atlach lour (4) copies ol plans lor proposed worh - Draw to scale antl no�e ihe fallowing as applicable: <br />• Propeny Lines <br />• Outline and dimensions ol all existing and <br />pmposetl slruc�ures on the lot <br />• E:iS��ng and propoeed utilities <br />• Centedine of stree� <br />• Indicate North <br />• Show any pwposed 9rading changes <br />• Show measuremen�s <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 pedormed in accordance with Ihis permit and current Cily of Everett Design and Construction <br />Standards and Specilications. <br />3. Call location Underground Service 48 hrs. belore you dig. TOLL FREE NUMflER 1•800•424-5555. <br />�{. �'r a��rn-..F��a/�.r �lf�� /-/9-)0 <br />� � i �C i 7'�' � �1'�-�,�_,�� ,�-�«�-�-=�� <br />�� �j� �� s ��' �vo <br />w�� ���� �ssr<��_ � � <br />�f� <br />_r � <br />App ved-`§� C struction Date <br />/ � / <br />/�.! � .0 �% �/�/'� 5///�-% <br />FINAL INSPECTION� � ' Date <br />Appmved as Constmcled <br />eveielt PUBLIC WORKS DEPARTMENT <br />� 3200CedarStreet <br />Everett, WA 99201 <br />Phone:259�8810 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />�w <br />_ / <br />Z <br />0 <br />� <br />The undersigned owner/applicaN here7y agrees to holtl and save harm- <br />less ihe Cily ol Evere�t Irom any and all claims for tlamac�es. cosis, <br />expenses, or cause� I attion �hat may arise because ol ins�allation <br />and maintenance o e improvemen� or olher righl-ol-way use hereto <br />applied lor and tur er agrees to remove same upon noiice fwm the <br />Gilv and lo reoiace ouUlic F�oPerty danaged thereby. <br />Sj( n5�ure ol ApPlicant - Uale 'I <br />4�VORK AUTHORIZED BY THIS P h IT MUST BE STAFlTED WITHIN <br />180 DAYS OF DATE PERMITIS UED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMFLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANV STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />