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Date—l�rs-`�' v <br />PUBLIC <br />Print or Type Only <br />5�'u/M9 �!� <br />Ownei <br />u <br />� <br />Application <br />WOR Q <br />O <br />i <br />a <br />0 <br />N <br />t�4aiiinq <br />PA��Im , Address <br />� <br />PuU��c \Porhs Pwm�� • " I `� • <br />0��9 Den� • - <br />Puldic Works Fce S <br />tnla� :rc <br />Less 4ppl Pri• Pa�.] S�� <br />palanre, Ouc 'J <br />GG2-322Ua/��3/ <br />L�p Phono <br />City Zip <br />Describe Propos��c Work a �--_= "_/� �—�� --�� �•�e — <br />�i.�s-'1�___ <br />3 �, r� o c�b�� �arsLs- - — ----- <br />Project Address �d known! -YJL�/ [� %�� - -���—�0�+�� <br />Attaeh lour 14) coPies of Plans loi nwe,osed wo�� � D�av: t❑ ,cai.• .u,n naie in��'o�lu�sing ae: aPUhcabie. <br />• Properry Lines <br />• Outline and dimensions ot all existiny anA <br />proposed sUuctures on the lot <br />• Exisling and proposed u�ilities <br />• Cenlerline ��� Sireel <br />• Irtlif3�o Nor�h <br />• Snom� any r.ronosed gratlmg changes <br />• Show measuremenis <br />PERMIT CONDITIONS <br />1. All calls tor inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be peAormed in accardance with this permit and current City of Everett Desiqn and Construction <br />Standerds and Specificelions. <br />;). Cal� Location Underground Service 48 hrs. before you dig. TOLL i=REE NUMBER 1-800�424•5555. <br />�� ��i �' �"p�'�°`.�d I' l�n d�tf�� ��9�9�f". <br />for Coyylruction <br />FINAL INSPECTION <br />Approved as Conslructed <br />�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett. WA 98201 <br />Phone:259-8810 <br />_— __'_ ._._—_' <br />� -y�_ � <br />Calr. I <br />i <br />- 3- <br />ACKNOWLEDGEMF.NT OF CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />0 <br />� <br />� <br />0 <br />a <br />The undersianed ownedaPPticxnt hereby agrees Io hold and 5ave harm� <br />less the City ol Everett Irom any and all ctaims for damages, costs. <br />e+penses. o� causes of ac�ion Ihat may ari5= because of installation <br />and maintenance n! tne Improvemenl o� other nghl�of-way use hereto <br />i;,�,im�; lor and further agrees to remove same upon notice irom Ihe <br />C h; ,v;d to replace ui�Ulic pronerty damaged thereby. <br />�O �� �/,�l � <br />S �natwe ol ApPllcant Da�. <br />14'ORK Al.'THORIZED BY THIS PERMIT MUST BE STARTC-D WITHIN <br />t90 DAYS OF DATE PERMIT IS ISSUED AND THERE\FTER IS TO <br />BE DILIGENTU' PURSUED TO COMPLETION. THIS PEHMIT PdAY BE <br />CANCELLED BV THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PRO.IECT OVER 90 DAYS DURATION. <br />