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0 y � N <br />� <br />p � <br />� �y � <br />ottl0 <br />'q N �0 <br />t�N � <br />9 O <br />'3 <br />� :° � <br />t' y � <br />N `3 <br />N <br />M <br />O N <br />�y�y� <br />H O N <br />Date _ <br />qpplica�ion For <br />PUBi.IC WORKS PER11AlT <br />Print or Type Unly <br />� <br />�esr.rihe Proposed <br />r j,cv L� <br />f/ueLu <br />` -Z 13 <br />Mailin9 Address <br />� / 3 °-f ' <br />Mailing Address <br />r�mi�c wo,.s m.,��n . `'I L u� <br />o�na o�oi., - <br />Punl¢ worxs Fca 5 <br />Total Ff.e <br />lesslp0� Fen Pad 5 <br />oai.,��.00�o S �C'� <br />ST. S ��� c u��� <br />City Zip <br />$ j . $ /_[i. E✓C'��e Z <br />.,, �f L [ ✓ E' uJ<< <br />e <br />Cily ZiP <br />-�vd � �'� %�G <br />SL✓ <br />��D 3 Z �� -�-�1G <br />Phone <br />d j Z}J^S-�(D <br />Phone <br />� <br />S'I . <br />�/,,� ti-, � s <br />Project Atldress (il knowN �—`�='- — <br />AUach lour (4; copies of plans Icr pruposed work - Draw to scale and nole the folloviing as applicable: <br />• Prcperty Lines • Centerline ol street <br />• Outline and dimensions of all existinc� and • Indicate North <br />proposed struclures on the lot • Show any proposed grading changes <br />Y Existing and proposed utilities • Show measurements <br />LI <br />PERMIT CONDITIONS <br />1. All calis for insoection shall be made 24 hrs. in advance - phone 259•73810. <br />2. All werk shall be pedormed in accordance with this permit and current C�ry of Everett Design and Censtruclion <br />Standards and Specifications. <br />3. Call Location Underground Service 48 hrs. belorr� you dig. TOLL FREE NUMBER 1•800•424•5555. <br />�-I � �(��dYl� �7v /1'I.�C �! l�Vi 7 11 � T ����C �r 1y R'! J� �(- ,.J/.GY 't� <br />i�'�� /'7Ir �% LL�GQ7 n„ C�/ // .,��'1i i i �' •�� /JLL�ifiR%� <br />�..��5-%�f�� <br />7�� � <br />�(�(�lt ,% <br />anoroved for Con! <br />) <br />FINALINSPECTION <br />qpproved as Consiructed <br />��r�PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Everett, WA 98201 <br />Phone: 259�8810 <br />.��� 7-i� <br />Date <br />Z� <br />� <br />�' � <br />_ I <br />o ' <br />�. � <br />ACKNOWLEDG[MENT OF CONDITIONS � <br />7he undersi9ned owner/apPlicanl hereby a�rees to hold and save harm- � <br />less ihe Cily ol C-veretl Irom any and all claims for damages, costs. <br />expen��es, or causes ol action that may arise because ol instal�ation I <br />and ma�ntenance oi ihe improvement or olher righbof-way use hereto <br />applied ior and further agrees to remove same upon notice Irom Ihe <br />City and t.� replace public nroperty damaged ihereby. <br />-�< 7-:Z Q � , -� (0 3 G2. <br />Data � Date <br />Signalure a� ��P liCarl <br />WORK AUTHORIZEO BY THIS PERMIT MUST PE STARTED WITHIN <br />1D0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFiER IS TO <br />BE DILIGENTU' PURSUEu fu COMF'�ETION. THIS PERMIT MAY BE <br />CANCELLED BY iHE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECT OVEP 90 DAYS UURATION. <br />