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Date � �3 <br />APU��calion For <br />PUBLIC WORKS <br />Print or Type Only <br />��� � ��� �EIN2�ERL <br />���;�,;��,; <br />p <br />a <br />PERM�7' <br />a <br />O <br />O <br />� <br />N <br />� <br />Aunl �1�ZIER[.. 1'!�-MtJ.��«ee, <br />APPlicant 4'.,�In�� , Addm^,s <br />Describe Proposed Work ��(.CZ.Ii (� ��''1n,,�,, <br />1�� �,-n(�r'�l�' �'�^�.1� <br />W.YIA(17ih.� .XW��� � /�---- --- <br />V <br />Project Address (if known! <br />rQ �U,� <br />O O <br />PJ C' I <br />�� <br />FuUI¢ 1YOrM1 Prlmit • ��1 �j{' I ' / <br />—1-7— <br />[3b�q Oen� • — <br />F'uliAc \VartS Fri. - -- <br />Tolpl Fee $ <br />L1!55 Appl iP,C PTi'� 5 <br />Jaianc.. o�c S _ �%�' <br />A�taCh lour 14) Copies ot plans loi proPo5e.1 tivorn � D�sr: 10 .c,ii...�n,� nntc tha'oqc�:nnq aG aPUhcahie <br />� Pronerty Lines • Cmcterlinr nf SheNt <br />• Outline and dimenswns ol all exi5hnq and • Intlic�b:; Narth <br />proposetl slructures on Ihe lot • Snov; any r.roposeA qra[!mq r.hAngrs <br />• ExiSting and prop05etl uti6ties • Show measuremen�s <br />Phqne <br />a.�-a-�5�1 --- <br />Phone <br />PERMIT CONDITIONS <br />1. All calis for inspection shall be made 24 hrs. in advance - phone 259•881 O. <br />2. All work shall be pedormed in accordance with this permit and current City of Everelt Design and Construction <br />Stantlards and Specifications. <br />3. Call Location Underground Service 48 hrs. belore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�'• � Gr �i.� S�"/�G� G�P�h �� R �� ��1' � f �"��(�— <br />/ �f <br />� i�Si?�'J C� �1 J r' / Gr'� Gi -{� i�'! S�G�YI Cl�Yl'G7`;%-j . <br />i <br />.� US� G�� .Sf2�yld�✓d �32.9. .�s rr/�Td/�ytR. �.�►-� <br />Gd�15�Yt/��M� Y�7G�-/�j . <br />� � <br />(p. /�� ✓IO�f-�XG�� 3� Gi2r�!-t� w;� �?� y�,�d se�fj�w/� <br />c�r¢a �5 d��F,'� -� zen n-r� code. <br />�����'�'l%� �%��� <br />Approved fOr Construction p����, <br />� �y<,� �«=s � .�� ��- �/�,- <br />FINAL INSPECTIOt�i ^ �., Date <br />Approved as Constructed � / ]/%/ <br />� ��� <br />PUBLIC WORKS DEPARTMEN�- <br />3200 Cedar Street .? -.Z 9• f� <br />Everett, Wq gg2p1 <br />Phone:259•BBlO <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDG[fdENT OF CONDITIONS <br />i h�• under��qned owner�apphcant hereby agrees to hold and saee haim� <br />Iess ;h�r Gity o� Everelt Irom any antl all claims tor damages, costs. <br />r*penses. or ��uses of aceion Ihat may anse because of inStallaGon <br />anA mainten;tnr,e o! �hn improvemen� or o�her righl�ol�way u5e heieio <br />ary�^c"f and lurther agrees lo remOve samn upon notice Irom Ihe <br />Cr �.ir.d in i�pl�ca pro erty damaged ihereby. <br />�a��b , �� f'Q,� ��,.�, n � �2 _�, l <br />', iqnalure ot Apphcan! Date � <br />1NORK AUiHORIZED BY THIS PER, MUST BE P,TAR7ED WITHIN <br />�80 DAYS OF DATE PERMIT IS ISSUED ANO THEREAFTER IS TO <br />8E DILIGENTLY PURSUED TO COb1PLEilON. THIS PERMIT �dqY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRpJECT OVER 90 DAYS DURATION. <br />