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,12 -� -S � <br />ApPlicntion For <br />IPUBLIC WORK� PERNlIT <br />Print or Type Only <br />Ap�licant <br />Mailinc� Address <br />Mailing <br />Cily <br />�.,,,,� � w<.,.s �•,,,,,,,, . _8%S�oS� <br />e�nu ooni a _ <br />r�e,ec woiha Foo <br />toinir�n S! <br />LPS] RpOI �CC I�R1J '1 <br />oaie��ao��o g 3So0 <br />Phone <br />Zi� Phone <br />Describe Proposed Work �.�S�L�I— CRTCli t7/i��) l��% (�.[j(�//JLZcit 1 V _ <br />S'f�2 rr� DKR/N <br />Prolect Address lil known) <br />Attach lour 141 copies ot plans lor proposed work - Draw to scale and note the following as apPhcable <br />• Properry Lines • Centerline of sireet <br />• Outline and dimensions ol all existing and • Indicate North <br />proposed structures on the lot • Show any proposed gradinr changes <br />• Existing anJ proposed utilities • Show measurements <br />PERMIT CONDITIONS <br />1. All calis for inspection sha�l be made 24 hrs. in advance - phone 259-8810. <br />2. All wo/k shell be peAormed in accadance with Ihis permit and current City of Everett Design and ConstrucGon <br />StanAa�ds and Specifications. <br />3. Cell location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1•800-424•5555. <br />` CUO/L� To d� t�o,v�' �,E'iz APP�a ✓Eo .fJrErcrr <br />ZaTEa /2 d8- 87, �9n'AGyEDJ <br />'.�, ni�i7G/C�i�% V/i��(lLd� T9KE G�r%d� a.if/OTS /�.�`O.f� <br />.�i�GiNi✓iN( [.�/o,e.r To .v�rb.c'i�,..✓.� ir T.4.�s <br />,�iticSTr7CC9T�o/✓ /S �SJ'//�'GF. <br />�i'�� �' a�'�_ /�8�� <br />Approved for Con tructic ale <br />� �•z-F� <br />FINAL INSPECTION Date <br />Approved as Ccnstructed <br />everett PUBLICWORKSDEPARTMENT <br />� 3200 Cedar Street <br />Eve�ett. WA 98201 <br />Phone:259-8810 <br />ACKNOWLEDGEMENT JF CONDITIONS <br />W <br />H <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />Tne imders�gned owner/applicant heieby agrees to hold and save harm• <br />less Cie City ol Everett Irom any and a I elaims for damages, eosts. <br />expenses. or causes ol action ihat may arise because of installation <br />and maintenance ol the Improvemenl or other righ�-obway use here!o <br />applied ir�r antl furiher agrees to remove same upon nolice trom Ihe <br />City antl to replace public property damageJ ihereby. <br />�/"Rt .SOu,vi� �'7�,�'v[R�m. .r� <br />; � � -�l�i /2-az-F7 <br />Sisnature of Applicant Date <br />WORK AUTHORIZED BY 1'HIS PERMIT MUST BE STARTED WITHIN <br />1&0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />i c DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVER 90 DAYS DURAiION. — <br />