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f; <br />CC t' '�9 <br />ro <br />q C <br />b � N <br />� <br />� N A <br />� M �V <br />V <br />N M <br />� �i � <br />� <br />� � Cl <br />n• <br />b ��-] � <br />, <br />t H y <br />N <br />CCCjjj C N <br />� � Y <br />y ic <br />H O m <br />...r' — ....._.. _ . . . ' " - . <br />/ J <br />Date� �� �� =.. , <br />Applicalion Por <br />PUBLIC WORKS <br />_l <br />Print or Type Only:� � ;� `, <br />��1 --�.L-) <br />' C ] -' f• <br />. , �.a u+ � <br />G <br />Owner <br />.._..__ ._.. ._.'.........._. .,....- . __.__.._..__. .__'.. <br />.._.�..... I a�oi�cwo�k:r��mn. ////YJ�9 . <br />omq o�m • � <br />PERMIT <br />��1��v5 �!U. �30� �o0 3 <br />Mailing Address ���Y <br />�Il-�Ec � % 1 � 1:,�� h C <br />Mailing Addres: City <br />Pum�c warxs Fee � <br />Tolal Fea <br />�ev RDo� Fee Pad 5 <br />�5�� <br />ea����� o�o S <br />ooZ-322- Yo - Do0-//-83/ <br />>/Gtv f� 1 CJ ZO � <br />ZiP �7e �j J z 1 <br />9slT_ol 7��-z/5'� <br />Describe Proposed Work rtU C��� � �'�'b `Z <-�f \� � L ���f rJ I7Jl� 1N 1"I-�� <br />iJ c� N'f�-1 6 w r7 Of' -i1{ t �j5" G? l`i•t A C f An l r; I��cl/ U.7 Ii <br />— t,. _ � .. . �,. ii To .�. ZcL� �' �.�t�'F_f_"rr <br />Proiect Address (il known) '� Y �� <br />Attach lour (4) copies ol plans lor proposed work � Draw lo scale and note the following as applicable: <br />. • Property Lines • Ccnterline of street <br />�"' . • Outline and dimensions ot all existing anu • Indicate North <br />'��- � proposed stmctures on lhe lol • Show any proposed �ratling changes <br />� • Eais�ing and proposed utilities <br />• Show measurements ; <br />� , <br />_ <br />�== �� <br />E <br />PERMIT CONDITIONS <br />1. All calls lor inspec�ion shall be made 24 hrs. in advance - phone 259•8810. <br />2, Aii work shall be pedormed in accordance with this permit and current City ol Everett Design and Construclion <br />Standards and Specilications. - <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FFEE NUMBER 1•800•424•5555. <br />� 0[�tcti S�itiE'/ �G /La. f�' � <br />• Z�i�f� � �'. <br />-or� c�-C E':.J �J�' ,:JCd�1<t a c.-i�X ( 2 l. <br />✓ C/ <br />O'... �(/u(/ C/�//G`CuJ/�� J'�lDt�'��G:.�G�'�c�-t�C�ri�.,Gf� �'���� <�y�i. Si. <br />�x'.�.U�u.Ct�. <br />��;�.� ..... „ <br />� �� /s / <br />Approved lor Consy t�o � , / Date <br />�\/ / _ <br />'' 6'� /� -s � <br />/.��c� ._i — <br />FINAL INSPECTION Date <br />Approved as Conslructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Streel <br />Everett. WA 98201 <br />.- Phone:25�J�8810 <br />Z <br />O <br />♦�� <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/app:icant hr.re6y agrees to hold and save harm� <br />Iess the City of Everelt from any and all claims lor dama9es, costs. <br />expensea, or causes o� aclion �hal mny arise U0Cau5e ol ins�allalion <br />and maiNenancc of lhe impwvemenl or ot.�er rigM�obway use hereto <br />applled lor and lurlher a9rees 1 ir^move same upon notice Irom the <br />Cily and I,o rOp�ace public o er dama9ed thereby. <br />— l,/�:� \ <br />�i�! � ' �`-.J � ' `� � <br />Signalure ol Applicant Date <br />WORK AUTHORIZED BY Tl11S PERMIT MUST BE STARTED WITIIIN <br />1D0 DAYS OF DAT[ P[RMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED 1�0 CCMPLETION. THIS PERMIT tdAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />