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o�,�: � } �� �`� <br />PUBLIC <br />Prmt or Type On�Y <br />�f.9n/ ,!. ���v <br />Owne� <br />��qLLr �: /fr✓[� <br />ppplir,aM <br />APPhcaticn fni p; <br />WORKS �ERMIT <br />� <br />0 <br />� �o <br />z <br />� �� <br />., -,.., , G�ti [iF <br />MaJmg�dtlrc�� � <br />� � � W <br />��1�� � <br />M[+Jmq Address <br />���C C�fT __--_ <br />Descnbe P�opoSed Wo�k � <br />Prolect AdCies5ld krowr' <br />f <br />nm��� wo,�e r..�mn . —���_. _�.i /, . <br />�ur,y Dro� • . <br />remm won. fen <br />toteiree s -� <br />,e„ e,,,,� �.a �a,a $ a--�, <br />uaia���n�� S n <br />;rol'�iT 5b�/ <br />CdY 7_ip <br />:vr �i %�au <br />cnv av <br />d te the tollowing as app�icable' <br />Attach low 141 coG�es ot P�anS �Or propo5ed wo�k - D�aw �o scale an no • CCnierline o� 5lree� <br />• Pwperty Li�es • Indicale North <br />• Outl�ne �nd dimensions ol al1 ex�sl�nq anA � Show any pronoseA grading changes <br />proposed S�ruclures on Ihe Iot • Show measurr.ments <br />• ExiSUnq and prOPased u�ilAieS <br />,�,� � G �-3 <br />Phonc <br />Ph�� � l <br />P[i;MIT CONDITIONS <br />1. All calls lor inspeclion shall be made 24 hrs, in advance � phone 2$9•8810. <br />2. All work shall be pedormed in accordance with ihis Cermit and current City ol Everelt Oesign and Construclion <br />S�andards and Specifications. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800•424•55 . <br />��! JW-(� L� C��-(_('t"�G.:y �F.�L ��� t� S�r: ��_i!I i.� ���: <br />�� 3C6' _ %?c�zl'�� S<��.c•�:-jf', �u (o �'Z'/°c�fi� <br />' ✓ .�ic2`'u.�c..- C+�,.�� 1 <br />r'i ,..a/ �h':'7. Ct�J9m-v •,•� Cv,-� <br />_ ' �'/�O <br />���`. <br />S< <t , . ,: C�� <br />�9/�! � �7'/J � '�'� � <br />���',`��r-`7 ••� � / �-' (_ (' _ /� <br />I �C��YJ � J�4 . f i�C/ l <br />�i t � f=�%i�.:�,'ir'�C"� /��Zf�' i�l�% <br />� �� <br />"� ��� r/ ���,, �,�- � <br />Apnrovea lo� Gonslr ction <br />Date <br />/�%r"�1�� f-i-�'/` <br />FINAL INSPECTION Dale <br />ApD�o�ed as Construcled <br />everril PUBUCWORKSDEPARTMENT <br />� 3200 Cedar Street <br />Everett. WA 98207 <br />Phone-. z50�8F310 <br />0 <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMHNT OF CONDITIONS <br />1 iu= unAeisiqned owner/apP�icant hereby agree5 t0 hold and Save harm� <br />ies; ih�:� Gty e� E�erett Irom any and all claims lor damages, costs. <br />expensr,s, o� causes o� ar,tion ihal may arise because ol installation <br />and mainlenance ol ihe improvement or other righl�ubway use hereto <br />apphed lor and further agrees to remove same upon notice Irom the <br />City ai�d�rePlace public property damaged thereby. <br />i ��^ <br />� � . � — `j T .� 1 <br />''r �Dal� <br />Signature ol App6cant / <br />gORDAVSTOF DATE� PERMIT ISE SSUED AND THERE FTDER ISH?O <br />BE DILIGENTLY PURSUED TO GOMPL[TION. THIS PERM1IIT IdAY BE <br />CANC[LLED BY THE CITY UPON ANY STOPP/+GE OF WORK GN THIS <br />PROJ[Ci OVER 90 D�YS DURAiION. <br />