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Date �� :� <br />Applica�ion For <br />PU6�LIC WORKS <br />Print or Type Only <br />Owner <br />Applicant <br />T�ubn�TlNf, lo-z�-a�l <br />m <br />PEF�MIT <br />O <br />O <br />� <br />� og <br />� �� <br />m <br />�. � <br />V^:a�yn�. .1�:dress <br />6'.,�Inia rl <br />!_�n <br />Ci <br />rt1' �ip <br />o„����,vo,,, PP,m�, .� � 6 9 / <br />6inn De�l • <br />Fub4c Works Fee 5 <br />iotN �ee <br />1e55 <oN F✓e Paut 5 <br />00 <br />or�a��,. ��� s 3S— <br />noz - 3azs�o i �s3 / <br />rnn�c <br />_ 3_�S�_��_ <br />PhonP <br />DescribeProposedWo/rk� � V_at�LGtii__ ��_�-�Ll�! tV.—S�+^�_� �� 2i�i---i-tL�� �" <br />�1/C S�.W*c.I"/wlo. _..—_—._________ ____—_—_ _ __ <br />--- ------ - . __ - - ----- ----- <br />, <br />—�J� --n- -Z�-W_-Ma����._V_l�ew-1 �--��w,}�-- <br />Prolec� Address Id known! _(./CQ'/�{L �C%'.S�n�e- �We�` __ eUia�CGf/Gn ,�__— �r/O!1 <br />/ <br />AttaCh fcUr IS) coUies .�I plans (o� proPuseJ wu�+ � Diav. to .•nii:, .�;:,� ni:!e U�r'oiloWing as appiicahie: <br />• Property �ines • Gente�line nf street <br />• Outline and dimensions ol all exi5tmg �nd • Ietlicat�� North <br />propOsed siruC�ure� on the Iot • Sho�+• anY f%fOpOSPA tJfOd�O� Ch]i1JeS <br />• Existing and proposeJ utillhes • Shnw measuremerts <br />NE <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be performed in accordance with this permit and current City oi Everett Desi�n and Consiructinn <br />Standards and Specifications. <br />3. Call Location Under9round Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />`� p� PQ�.�f P�� c�:f� .s��,-,.��0 �.�.b (�nPyt�4����) <br />S /f"2�C-/J .sE'C_/iOr) QnC, Uc�n� Pe�- STttio�ith� (l���% ¢��v/�� <br />CL(//'�i7in Sf�C f% (CC7P� A//I C�1 t�) <br />�, �eP �r�y 5'free�`s Cle�r t-, 4 t c LL 7�iMes' <br />7. /�r�✓,�-�e 7�'4'�/G Con��.L 2s r�eedea! <br />•�• h7G'di tti?� Ci�j /nSParor be�rc �vAi�� �i�n�,� <br />=— �' ��� <br />Approved tor Construc io � . �' �" <br />.�`� .�,�� -- �o-�+- 9y <br />FINAL WSPECTION « <br />Approved as Constructed <br />�A�I�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everell, WA 98201 <br />Phone: 259�8810 <br />ACHNON'LEDGGMENT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />0 <br />� <br />� <br />� <br />a <br />�; h,� undci�i�ned owner�appocant hereUy agrees ro hold antl sa�e harm� <br />Ivss ;he City o� Everetl from any antl atl claims for Aamages. r.osts. <br />r�penses or causes of acfinn that may aris� 6ecause of installation <br />and maintanance o! Ihe ��nprovement or oth•v right�of�way use heretn <br />a;:i,bed for and further agrees to iemove saioe upon notice Irom Ihe <br />��;y i,�.d to re�placa PuUhC propeit)' dam�lgeA �herCbY. <br />C�,,.._ }�J U' s- � z�- ��{- <br />Signalwe of Applican! Date <br />VJORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />�80 DAVS OF DATE PERMIT IS ISSUED ANO THEREAFTER IS TO <br />BE DILIG[NTU' PUPSUED TO COMPLETION. THIS PERMIT MAY BE <br />GANCELLED BY THE CITY UPON A�JY STOPPAGE OF WORIC ON THIS <br />PRO.IECT OVER 90 DAVS DURATION <br />