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Date : r � ��/ ( <br />ApPlical�en Fo: <br />PUBLIC WORKS PERMI'T <br />Print or Type Only <br />/-�C;ci� <br />39- /%>' `� <br />�eb��r \Vo�hs Ferm�1 L�_ __ . <br />�m9 JCOt � __� .�,��� 7_ . <br />P„bi�c Won. i ae --�--_ — � _ <br />,��„� Fe,� s _. <br />less Rno� iae vnia S <br />eainncn nuo S ��'���� <br />Lp Phone <br />i1�11 L � -- <br />Applieant Ma��ing Addre55 CdY Z�P N���'O� <br />1 7 <br />Describe Pronosed Work �� p� l J�k� - <br />Pro�ed Adtlress lif knownl �8z T- j7�E��Q�c' (�1, <br />Attach four (4) cop�es ot plans tor proposed work � Draw to scale and nole Ihn lollowing as apPlica�le: <br />• Propeny Lines <br />• Omlme and dimensions ol ali existing and <br />proposed StmCtures on the lol <br />• Ezlsting and proposed utildins <br />`% <br />J� <br />' X� <br />• Centerline ol sircet <br />• Indicate North <br />• Show any proposed graAin9 chanpes <br />• Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 h�s. in advance- phone 259•8810. <br />2. All work shall be pedormed in accordance w;th Ihis permit and current City ot Everett Design and Conslruclion <br />Standards and Specilications. <br />3. Call Location Unde�ground Service 48 hrs. before you dig. TOLL PPEE NUMBER 1•800•424-5555. <br />1SC�-,,oZ� �X�:1L���� %�-i�c--a<_„>'� �<a C�L�;- ,i7:i,�1✓.i. � q� <br />s�.cr��v 3.3 y �. <br />/�)J,r� /, ,r� _/ / / <br />' J/ {! �cG lt�Yl� 7�t�:v (/J2�.t4-.tc/n.�/ �Q!'L �!.'�.+�y/��2� �.�1'7 <br />> > <br />- ��%�-�-�_ �� �� <br />Approved for Con t�(u/�p � ��e <br />/`�� � ����7� �/ <br />FINAI INSPECTION � Dale <br />Approved as Ccnstructed <br />evcrrtt PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Sireet <br />Everett. WA 98201 <br />Phone:259�8810 <br />AC,KNOWLEDGEMENT OF CONDITIONS <br />The unrersigned owneVapplicant hereby agrees to hold and save harm� <br />less Ihe Gdy of Everett Irom any and all claims for tlama9es, costs. <br />eapenscs, or causes ol action ihat may arise because ol installation <br />and malntenance ol the improvement or other righhol•way use hereto <br />applicd lor and further agrees to remove same upon netice Irom the <br />City anA to replace pubhc properly damaged lhereby. <br />, -i ,!i//^ �� <br />��-- <br />.- _/� . � �'7C`_� n <br />igna(ure ol AP�Iicanl� Date <br />WORK AUTHORIZED 9Y THIS PERAfiT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND TIIEREAFT[R IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERA117 MAV BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURA?ION, <br />