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Date�✓=� j% � <br />Application For <br />PUBLIC WORK� <br />O <br />r� <br />C� <br />Print or Type Only n <br />r, <br />�-i <br />.� <br />C'�i�✓ % O,v /�. w <br />$',4/�;/_`. <br />Applicant <br />PERMIT <br />O C <br />0 0 <br />M'.1 C 1 <br />� U <br />`T,ti�,E'cf EUC=iCt�rt�✓� <br />�ss�. rd S G�Y Zip <br />o • �n <br />o�-¢ <br />o:�Ll <br />3k ..] <br />Mailing Address <br />Po�uc Wor1,e Parmil • / �� �� � � <br />B�ao Deo� • <br />PuLi¢ Worts f ee S <br />totai Fee <br />tessanni�eenam$ �_ <br />Baix�on0uc $ ��n <br />�r - 3S'� .�6y�(- <br />�'- .a �,� _ <br />Phone <br />�.;stribe ProPosed Work �"i�,1/CbT Nrfd✓.vi� J'ICJ.vi o_F—,f'/fv j/c�tY � S'/��Lrf D/'" /J�OU.iCJ. <br />C y cCc�..v cr �L'.✓Ld'� ��.�12 �� fi�i� 4Crn� _�'i'an7� <br />Prolect Address lil known) `�7��' � <br />Attach lour (4) copies ol plans lor proposed work � Draw to scale and note the lollowing as applicable: <br />• Property Lines • Centerhne ol street <br />• Outline and dimensions ol all existing and • Indicate Nonh <br />proposed strudwes on the lot • Show any proposed nrading changes <br />O Existing and proPosed utilities • SYow measurrments <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance � phone 259$810. <br />2. All work shall be peAormed in accordance with this permit and current Ciry of Everetl Design and Cunslruc�ion <br />3. Call Localion Underground Service 48 hrs. before you dig. TOLL FREE NUMBEH 1•800•424-5555. <br />� ../.�ruG �QttG.{;� QG /Lei✓�..711�¢.`t Q7 G/1�C�[tb� <br />/i <br />; 0�, �� �uc.2 �iu�.r�4- ,Zo' u�:L'��/ �` � <br />�"b <br />%�-y/L�sLC.0 <br />jr _ <br />a/trti., <br />.T �`i� o�-.-f �' � � -� •nC�e/.�,.�...1-f�.�%� <br />. "`' �' �G.u-� "a' � �/ <br />2 7�c�n-l��ruc.y�.i c+,� �� i3.c%�t'" �itFi �,tc,/ �,c�•Ct.✓n-C� � <br />�. <br />�� <br />� <br />ApProved lor Gon <br />Date <br />�I��r��/ �l�-i�'� �'c� <br />FINAL INSPEGTION Date <br />Approved as Constructed <br />everetl PUBIIC WORKS DEPARTMENT <br />� 3200 Cedar SUeet <br />Everett. WA 98201 <br />Phone:259�8B10 <br />W <br />F- <br />� <br />� <br />O <br />ACKNOWLEDGLMENT OP CONDITIONS <br />The undeisigned owneiiapplicant hereby agrees to hold and save harm- <br />less the City ol Everetl Irom any antl all claims lor damages. costs. <br />eapenses, or causes ol action tha� may arise because ol inst'allation <br />and maintenance of the improvement or other right�of-way use herelo <br />applied for and further agrees to remove same upon notice irom the <br />City and lo replace public property damaged Ihereby. <br />���'�.iQ�'? —� 2� <br />Signalure ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT ��fUST BE STARTED WITIiIN <br />180 DAYS OF DATE PERMIT IS ISSU[D AND THER[AFTFR IS TO <br />(3[ DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT IdAV BE <br />CANCELLED �Y THE GTl' UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVLR 90 D�YS DURATION. <br />