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Date ��7 C <br />Application Fo� <br />PUBLIC WORKS PERAAIT <br />Print or Tyue Only <br />UP4', i ret'� <br />owner <br />�f�n1CF I�Ui <br />App6cant <br />Describe Proposed Work <br />Prolect Ptldress �il knownl <br />lrPbJ A �n17`r�� �2 �ti) � Cc )e.rT <br />Maihnq Addres; Cil <br />n - <br />, �s�� �3� �Cq��.��d� <br />Madiny Adtlress Cit <br />�J� � l � �'7',��� 2a�; 7-' .;� �i <br />� s� T�' C�?/c <br />Puo��cwor4aparmt ��/ 3� <br />B�CB Oeut • � ��.T (c' i� '_ <br />v�oLc woiMs Fe� G � <br />Tclal FvM $ �� �'�� <br />Less Pepl Fee Pai� S �— <br />�aienae Due S %�� <br />ZIP Pnonc <br />Sr.'h' ,�Q.,rfi. ��i,�i .3.1s-.1s5.3 <br />Zip Phone <br />D C.J <br />Attach four �4) copies ol plans tor proposed work � Draw to scale and note the lollowin9 as apphcable: <br />• ?f00Cr(y �InBs • Centerhne otsVeet <br />• Outline and dimensions ol all exlsting and • Intlicate North <br />proposetl structures on ihe la • Shew any proposed qrading changes <br />• E.Isting and proposed uhlih�s • Show measurements <br />� <br />DO NOT WRITE 6ELOLN THIS LINE <br />PERMIT CONDITIONS <br />7. All calls for inspection shall be made 24 hrs. in advance • phone 259•881 5. <br />2. All work sh211 be perlormea in accortlance with thls pernvt and curren; City of Everett Design and Construction <br />Standartls and Specilications. <br />3. Call Location Underground Servlce 48 hrs. before you tliy. TOLL FREE NUMBER 1•800•424-5555. <br />� ,J�=.0 �.�'f.L����O i�L���J.i' J�y�✓J.' <br />/ �7?: -✓'S� <br />G( TjG ! i/CJ' <br />W <br />1� <br />� <br />Z <br />O <br />i�CKNOIYL[DGE6fENT OF CONDIilONS <br />ihe unders�gnetl owner/apphcant hereby agrees to hold antl save narm- <br />� i lass Ihe Gty of Everelt Irom any .lntl all claims tor damaqes. costs, <br />� expen5e5. or cauSeS of acuon that may anse bec:iUSe ol in5eall�tiOn <br />� ��—� �/ �_ P� antl rn7iniBnance ol Ihe improvem¢n� Or olhBt riyh!�pf�way u5e heie�p <br />���'� y��- � ap�lied for and further aqrees to remove same upon notice Irom me <br />�ec`+e�Canslructi Oate C�ty antl to replace public properry aam2yetl therebv. <br />L i .ir ' <br />�— �t�.i_ y_ y <br />FINAL INSPECTION <br />Approvetl 25 Consiructed <br />cverett PUBLIG WOFKS DEPARTMENT <br />� 3200 Cedar Slreet <br />Everett. \NA 9f3201 <br />Phone:259•8815 <br />��-c ri�-�.�:� r.R �� t�cr�;v �— i r�s --c� <br />Signature ot Apphc�ht Jat� <br />IVORK :.UTHORIZ�D BY THIS PERMIT PAUST BE STAFTFD N9THIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS Ti`, <br />BE DILiGENTLY PUFSUED TO COMPIETiON. THIS FER611T 41AV 6E <br />CANCELLED B`f TH[ CITY UPON FNv STOPPAGE OF WOFK OV L1�S <br />PqOJECT OV[R 40 DAYS DUFqTION. <br />C <br />� <br />f: <br />r: <br />y ',-. <br />� �. <br />� ,r <br />�: <br />�, <br />n <br />r' <br />`. <br />� <br />;., , <br />K , <br />��. <br />t7 <br />(7 , <br />�'. <br />?: <br />