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[T7 C7 � <br />9 �3 <br />A�Vx <br />[ H <br />ayw <br />y 5 r�+ <br />�C C] <br />H x1 <br />o xo <br />�', N'TJ <br />V1 H <br />Hx tg" <br />C�] O LT7 <br />y Cy <br />H l� O <br />(i V �] <br />aN� <br />r z <br />HH <br />g� <br />H <br />��� <br />r <br />Csl <br />H O pr <br />Date `� YG� <br />Applica�ion For <br />�UBLIC WORKS RERMIT <br />Print or Type Only <br />APPlicant <br />Descrihe Proposed Work <br />Prolect Address lil known� <br />ng <br />n9 Antlress <br />c�oi�c �n^:V. n,.,..ef'. /��- <br />E�aa o�o� , G ' `�— <br />VubLc wor4s reo <br />Total FeC 5 — <br />lets Popl iee PaN S— <br />paiancc Due $ _ <br />Zip <br />—�— ZiP �— Phone <br />AtlaCh (Ow (4) COpies ol pl�ns 10� PropoSeA Work � Dr��v IO Scalc antl ne;e �he lolluwing d5 �pPli�able: <br />• Property Lines • Centedine ol street <br />w Oulhne and dimensions of all e+i;Lnq and e Indicat� Norlh <br />prOposed Struc�ures oi� Ihe lot • Show any pmPosed qrailiny chany��s <br />• Existing an0 proposed utihhes • S!�,nv: mr.aswemcnts <br />, .i cRMli COWDITIONS � � <br />1. All calls lor inspection shan be macte 2a hrs m advance - nnone 259•8810. <br />, 2. All work shall be pedermr.d in ;icccrA;,nce v ilh Ihis permd anA cwr; ni City ol ErerMt Desiyn and Conslruction <br />" S�andards and 6pecification,. <br />3. Call Lor,-,(ion Undergrocnd Snrvicr 4d hi:: before ;ou un1 70LL FREE NUMBER 1•8��•424•5S5$. <br />Construction <br />W <br />r <br />_ / <br />�1 <br />� <br />Z <br />O <br />-{� � i,�, lR%c� rc k j �-�,, vK i.i (L,�-' {' k��'�� IL���/��+`�� � <br />���1�� «� =- � <br />� �,-� <br />, f���, <br />FINAL INSPECTION <br />Approved as Constmcted <br />everett PUBUC WORKS DEPARTMENT <br />� 3200 Cedar S�recl <br />Everett, WA 98201 <br />Phonc:25�J�8810 <br />� <br />� <br />ACKNOWL[DGF_;�iENT OP CONDITIONS <br />Ti�e undersi9ned ov:�cuapplicanl herebYagrees to hold and saee hainr <br />less the City c: rvcreu liom any and all claims lor tlumayes. cosis. <br />expensvs, or causes ol action Ihal may �rise because ol ins1a11aGon <br />and maintenanr.e of ihe unP�ovement or othpi righ�-ol�waY �ise hci�,�c <br />�pplieA lor :ind lur�he�i ucpne9 lo r�movC came upon noha• hom �hc <br />Da�e C�IY and lo mPCfr:� Public Vr-Peity d.lmiqed tl�ere:l;y. <br />Date <br />Siqnulwe n� AUPIi.:anl D:tlo <br />WORK AUTIIOf71ZED E3Y THIS PERMIT AfUST 8[ STARTED WITHIN <br />180 �AYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGFNTLY PURSUED TO COMPLETION. THIS FERh11T MAY B[ <br />CANC[LL[D DY THE CI7Y UPON ANY STOPP�GE OF WOf7K ON TN�S <br />PROJ[CT OVFR 90 UA1'S UURr1TION. <br />