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��x <br />9HC~i� <br />��� <br />�yQ�H� <br />� H d <br />��8 <br />c]Y Ci <br />t"y� <br />Hy <br />8y <br />C] C7 VJ <br />�O� <br />Date �.T_�S�Ql <br />�; /�%-?9-� <br />.:,� h <br />Appliwtion Fo� <br />� . IPuc'i�c15'atsPe,m�� _ ___ <br />�ine oeo� . �1 �^:6SaS <br />PUBLIC WORKS PERMIT • °�°°°w°�°°F°° ---- <br />,o,,,Fe, s__ <br />lcss ADo� Fec naA g <br />a,L,oa� ooe s <br />Print or Type Only <br />Carl & Apsemary Eby 2505 Grand Ave. .x.Verett WA 90201 259-4"47 <br />Owner Mading Address Cdy Zip Phene <br />Owner <br />qpplicanl <br />Descri6e Proposed Nbrk _GdLdQe P �F 'a�'�.._.� _g 1 fY <br />Projec� Addres5 U� known) <br />Attach four (4) copies ol plaoe. �or proPosed woik - Draw to scale and note Ihe bilowing as applicable: <br />• Property Lines <br />• Outline and dimensions ol all ezistinc� and <br />proposed struc�ures on ihe lot <br />• Ezisting and pnposed utilities <br />• Centerline O� street <br />• Indicate Norlh <br />• Show any proposed gradine� chanqes <br />• Show measuremenls <br />Phone <br />PERMITCONOITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work sha'I be pedormed in accordance with this permit and current City ol Everett Design and Construclion <br />Standards and Speciticatlons. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />/ U J� LVDz� <br />.�i�i-n G�_ /U�, .�Ct�-r�-'-'� <br />0 <br />�r-9/ <br />Approved lor Construction Datc <br />FINAL INSPECTICN <br />Approved as Constructed <br />everett PUBLIC WORKS DEPARTMENT <br />� 32�OCedarStmet <br />Everelt. WA 98201 <br />PI one: 259-8B10 <br />ACKNOWLEDGEMENT OF CONDITIONS <br />W <br />H <br />�w <br />_ / <br />� <br />O <br />♦�^ <br />V♦ <br />O <br />a <br />The undersigned owner/appllcant hereby ag�eea to hold and save harm� <br />less ihe City ot Everett irom any and all claims lor dama9es, costs. <br />eapenses. or causes ol action that may anse because cl installetion <br />and mainlenance ol the improvemen� or other righbof�way usc heieto <br />applieA �or and furlher a9rees �o remove same upon notice Irom Ihe <br />City and b replace public properry damaged thereby. <br />SignaNre of ApPlicant ���e <br />WORK AUTHORIZED BV THIS f ERMIT MUST BE STARTED WITHIN <br />180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIG[NTLY PURSUED TO COMPLETION. TNIS PERMIT MAY BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON TNIS <br />PROJ[CT OV[R 90 DAYS DURATION. <br />�i <br />