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. <br />Date �' <br />, <br />� npplir,ation Fo - <br />4_ <br />PUBLIC WORK�i' PERMIT <br />nnt or Type On�l/y - ;" `; <br />��/��l L � ' "���'�� (�i��� �'; �"i � i <br />u: w <br />i'�' 1 .`3 � . .�;�1� <br />Ownei Madmg AtlarCssli _. <br />oi.-•. <br />�i� r,:i _t �.J <br />��///9 �� � 1 i i s lil <br />'I. ��r�Q/� �GG%C�p:J �� - a: o � <br />Ap icant Mailing Address <br />�� ��//jL/�� �/ <br />D cnbc Proposed lNork __. L l // P/z� d 6'�% � <br />7 , <br />l,/!1 tl � {'PI��<f��F� �nioi: f�7iJ�/ic� <br />G %� <br />Pro�ect Address UI knownl <br />, <br />Put�lic WorFSPormit • ��� '� ��� <br />Pnf9 Ocpt � . """. <br />V�IIIIif W0�F5 �1!V <br />i0�111 FCI! V _� _� <br />1e55 Appl 1"ea PaN S��r,,.�_ <br />e,,�.,,,,,, n�� S �21-�Y� <br />� , ` ' /'i <br />, o <br />Y 7.i <br />( ( �� <br />V Zip <br />Attach tow I�) copies ol plans lor proposed work � Dr, w tn scale and note Ihe lollowiny as applicable: <br />• Properfy Lmes • C�nteilme ol street <br />• Ouihne and dimensions of all ezlslmg and • Indicate No�th <br />proposetl sVuctures on the lot • Show any proposed �rading thanges <br />• E*ahn9 and proposed utihties • Show measuremenis <br />`�s� - G/L <br />Phonc <br />!f <br />Fnone <br />�!_C' %� I�l� � <br />PERMIT CONDITIONS <br />t. All calls tor inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shall be pertormed in accordance with ihis permil and current Ciry of Everett Design and Construction <br />Standards and Specilications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-500•424•5555. <br />,� , / / <br />• - �. . �C�! f"' C <-Ti .,. t ,`.7`., i,�.. , '� ,��_.� ' :%' F1'�.. <br />p � . J" � <br />�/ �1 � , <br />. <br />. - �i2c.1 �Clm w� �/ i� ��t-%. � i , �,j �.. I / .! � - . _ . � . � r .� ' <br />/J � <br />.' i�r,� ' . . . _ �;r!" . ,a. , <br />/ � . <br />/� <br />fINALINSPECTION <br />Approved as Constructed <br />eria�•il PUBLIC WORKS �EPARTMENT <br />� 3200 Cedar Slreet <br />Everetl. WA gq201 <br />Phone-259�8810 <br />Date <br />Date <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDG[MENT OF CONDITIONS <br />ihe undr.ryigned owner/aUPlicant hereby agrees to hold and save ha.m� <br />Iess the City of Everetl Irom any and all claims for damages. costs. <br />expen�es. or causes of aclion that may anse Uecause of installatwn <br />and m. intenance ol �he improvemenl or o�her nghPol-way use hereto <br />applietl for and �ur�her a9ree5 to remove same upon nolice Irom the <br />City anc to replace public property damaged Ihereby. <br />1.�,/-1�� n!-sE 1'��`� ��.�c� _/D/� <br />Signalur� �I ApphCant �/� �� <br />WORK ITHORIZED BY THIS PERM�T MUST BE STARTE WITHIN <br />180 D4�� OF DATE PERM�T IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED i0 COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITV UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />