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Date�B i <br />' ~ PUBLIC <br />Print or Type Only <br />Applic�tien FoN <br />WORK� <br />O <br />� <br />�i <br />� <br />PERMIT <br />�u' g <br />ci o <br />C1 CJ <br />Pupl¢ 1Portn Perm�l r �+ � _� ��_.—�/ <br />uinn Dan� • <br />��„„�,� Wo,—�, �,.,—s <br />rmm rc� <br />lass Ann�. 1 en Peut S O <br />u.,i,��.� o�„ s 'rLG � - <br />� !JG n <br />Descnbe ProPosed Work �b Ro���_ l� 6Z �1rl.Vfl <br />SJo�e /1�T 1/.L /`tSi�I �CQ �— C �f-Nr�� r.,,�Y <br />�� <br />Prolect AdAress Id knownl C3O� J�H/� �"/- ' <br />Attac� four (41 copies ot ptans for proposed wo�k � Draw to scale anA note Ihe lollowing as apphcable: <br />• Properly Lines <br />• OutGne and dimensions ol all eaisting and <br />proposed sl�uctures on the lot <br />� E.ist�ng and proposed uti!dies <br />• Centedine ol street <br />• Indicate North <br />• Show any proposed grading changes <br />• Show measurements <br />PERMIT COtJDIT10NS <br />1. All calls for inspection shall be mede 24 hrs. in adva�ce • phone 259•8810. <br />2. Ail work shall be peAormed in accordance with this permit end current City of Everett Design and Construction <br />Stendards and Specificntions. <br />3. Call Location Underground Service 4B hrs. before you dig. TOIL FREE NUMBER 1•800-424•5555. <br />S� �9LL Ti� Si-7 Gi/� <I />>F_ _f>i.r/l— aL'�Ts/ Tf/E <br />/��ifj'LiC !a�l�,c;rS /�SPE�il�� f�EF�.c�� h'r�i�vn/in��� 11/n,�Sf' <br />, " <br />�2 �Ir"n/%— 7-2G•—�`L <br />Approved lor Gons , on / Dale <br />����I 3 /6 - �'. <br />,_ <br />FINAL INSPECTION Datc <br />App�oveA as Consiructed <br />everett PUBLIC WORKS DEPAR7MENT <br />� 3200 Cedar Slreet <br />Everelt. WA 99201 <br />Phone:259�BB10 <br />�CKNOWLEDGEM1IENT OF CONDITIONS <br />W <br />H <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />The undcrsl�ncA owner/applicant hereUy agrees to hold and save harm� <br />less ihe City ol EvereU Irom any and all claims for damages, costs. <br />expenses, or causes o� action that may arise because ot installation <br />and maintenance ol Ihe improvemen� or other right-ol�way use hereto <br />applicd I nd lurther agrees to remove same upon notice irom the <br />Ciry and lo eplace pubtic pwperry damaged Ihereby. <br />���//..____ � � -�� <br />� Dale <br />Si9natur o ApPlicanl <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />tB0 �AYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS ?EFMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJ[CT OVER 90 DAVS DURATION <br />