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Date ��� ��� <br />Applic�tian For <br />PUBL1� WOFiKS PER�IlIIT <br />�rint or Type Oniy <br />� � <br />S�n�1ts,, r';� � � G, d N�•� <br />Owne• 'Ma:ling Ad�r?55 <br />Applicant <br />Uascnbe ProposeC Work <br />Mailing Adtlress <br />Prolect Address lif knowr;l _ <br />�C G�� — � /�� <br />cav z�p <br />^ �l � h <br />h� ' �,: <br />�ubi�c 1Yorks Pcrmyil • ��" <br />���9. Cept • J�_/ / / —� O � <br />i <br />PIIbLC 1YpeF5 Ft0 S <br />TomlFce <br />Lesa Aool Fee PaiO S� <br />BaianceDoe 5 �C� <br />At:och four I�l cooies o1 olans fo� proposetl work • Draw to sctle antl note Ihe tollowing as app�icable: <br />• Property lines • CenteNine of stieet <br />• Outline antl dimensions of alt exlsting antl • Intlicate Nonh <br />proposetl structur25 on th2 lot • Shmv any proposetl gratlirg changes <br />s Existing antl proposed utifitles • Show measurements <br />PERMIT CONDITIONS <br />1. All calls for inspectlon �hall 6e made 2•i hrs. in advance • phone 259•8810. <br />2. All work shall be periormetl in acwrdance with this permd and current City ot Everett Design and Ccnstruction <br />Slandards and Specifiwtions. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�j�, (IS6 1�._^rv.��•vAt� C'v,e�Ei-CuTS /?E'U✓io.�.0 U•� Gc> F�Pi�,�'O�/AC <br />`,zoin T�tr /�Ja'a�C t-�Jo,e,cs' ..ZNf�,Ecro,e �,� �c'�CUC�f'rieN, <br />�yr,v�/,1,/E� c�.��.vcsu/9y Srf9c� /�E I•�/S.—.9C[�,D .��•�' C�T� <br />S'T9.�o/,'Pv �3CJ- G/•r/v.r6o t�c��d.��9�r �S'f/.9� � �H,E�n/-UVT <br />.�,p ,Poi�'9C€� L���Ti/ F1LC �/c,�ri/r C[�,e�� $ �r�1�ti'. <br />5, G'�s6 S:a,em v,�.�•�,✓ S/r�� �,e ,ovc��/—S.�ovr�r <br />�Grr .e':�U= TJf� <br />T�E �f'i'l/CFi'�t/T fi�/FCL h:: .Ps�fi''cx/IYdL� �c� .c'�i�l�C'/NG <br />�. �.,,i Ci�ti�G; C-u.7E.2 ne d'i.o� �v9� Li'�'�,�.�1 /�U,zi.r/rr T.r� <br />C�� <br />jT,eIIC%/D� PiGD�6.iS� ACKNOWLEDCiEMENTOFCONDITIONS <br />Approved far <br />FINAL INSPECTION <br />ApP�oved as ConSlruCted <br />everett PUBIICVlORKSDEPARTMENT <br />� 3200 Cedar Slreet <br />Everelt WA 98201 <br />Phone: 259�Bd10 <br />� <br />0 <br />The undersigned owner/applicant hereby agrees to hold antl: iarm- <br />less the Ciry ol Everelt Irom any and all claims for dama �sts. <br />expenses, or ezases ol action that may arise because ot ition <br />and mamtenance of the improvement or other right-oFway .. �erem <br />appliea for and furiher agrees lo �emove same upon nci�. '���m Ihe <br />Ciry and to replace public property damaged lhereby. <br />I � a--,-+1 �.�tl�u�i y G �� _ <br />Siynalure ol APpiicanl Oate <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARI'ED WITHIN <br />1d0 DAYS OF DATE PERI 'T IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSL'ED T'� COMPLETION. THIS PERNIT MAY �[ <br />CANCELLED BY THE CITY UPON ANY STOPP�GE OF WORK ON THiS <br />PROJECT OVER 90 �AYS DURATION. <br />