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oatey''' �� <br />a Application For <br />PI�LIC WORKS <br />O p <br />ri O <br />Print or Type Onl�t <br />� o0 <br />N N <br />N __ � <br />Proposed Work <br />Project Address lif known) <br />PERMIT <br />���d ��SQ� I /Qk7��.5 <br />N � Mailing Address <br />�w <br />�� <br />Mailing AAdress <br />Ciiy <br />l.ny <br />ip <br />� <br />i <br />Pubi�c WorFs Permp • / �7' /�/•' <br />o�ae. eeci • _ <br />r�ei�� wo�ka v�a <br />To�elFec s <br />Le�s �pW. Fee PaiU $ <br />$ ��_�__ <br />Baiance �ue <br />Attach lour (4) copies oi plans for proposed work - Draw lo scele and ncie ihe follo.ving as apUhcable�. <br />• Property Lines • Centerline ol street <br />• Outline and dimensions ol all existing antl • Indicate Norih <br />proposed siruclures on ihe lot • Show any proposeo giading changes <br />• Ezisting and proposed ulilities • Show measuremenls <br />Approved for <br />LI <br />asa- <br />Phone <br />PERMIT CONDITIONS <br />1. All cells lor Inspection shall be made 24 hrs. in advance • phone 259•6810. <br />2. AI� work shall be perlormed in accordance with this permit and currenl City ol Everetl Design and Construction <br />di�7. TOIL FREE NUMBER 1•800•424•5555. <br />// � �� � <br />7. ,-��,�.ee. 'Yi7<c.17` L3C �%�- /�7�<.kt>'uc.,•�- � <br />�'':� <br />/�� /l <br />�-���^� �t7-ta.-y( ti2Y✓. � �Ct.c,.�Lc.. iJ�>LC.G- .,a- <br />G' � <br />/:hZi�•,e--� /�C��l('et /�/j��-� l<Jet.y/. <br />// <br />Jr CG�>'�l T<'r"ce' f��. �'`2'��e,( ��C�.mc'�.,� 1/ <br />�:/�'r��� 7� -1� i'l' <br />�� <br />FINAL INSPECTION' <br />Approved as Cons�rucled <br />everett PUBLICWORKSDEPARTMENT <br />� 3200 Ceda� Street <br />Everett, WA 98201 <br />Phone:259�9870 <br />Date <br />ACKNOWLEDG[MENT OF CONDITIONS <br />The undersigned owner/apphcant hereUy agrees to hold and save harm- <br />less the City ol Everett irom any and all cl�ims lor damages. costs. <br />expenscs, or causes ol action that may arise because ol installalwn <br />and mainlenance ot Ihe improvement or other nght�ot�way use hereto <br />applied lor and turther a9rees lo remove same upon notice Irom ihe <br />City and to replace public properiy damaged thereby. <br />�,�,,.-,1.-c �G1 �a�,j��X�, Y'-.3-YU <br />Signature ol Apphcant � Date <br />WO(iK AUTHORIZED BV THIS PERMIT MUST B[ STARiED WITliIN <br />160 DAYS OF DATE PERMIT IS ISSUED ANO THEREAFTER IS TO <br />BE DILIGENTLI' PURSUED TO COMPLETION. THIS PERMIT MAV 8[ <br />CANCELLED BY THE GITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJEGT OVER 90 DAYS DURATION. <br />