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Date <br />Application For � . <br />PUBLIC WORKS PERIVIIT <br />Priirt or Type Only <br />Pupi�n Wcrts Pnrmil + �' s.��7/�—/ <br />6m� Den� • <br />P„�,�,<<va,�sF,.� 5 <br />TO�II F�!p <br />L��55 Apul F�.. P.u:1 S� <br />o,i,,���� o��„ 5 �J7 � <br />;; . <br />S�-....__ 2 --------------- -� - --- <br />Applicant Dd:,llir�r, Address _r,it�a ZiP Phnne <br />Describe Proposrcf Work �Je�c�- ._ J�_�Ca,� -�P-�-_ �._��'-Ye ='f�-'Lj/--- ���—���—�-���C. <br />— x P ��-t9-�t _ _ f 5�A-U�' ' -- -- -- v — ----- <br />--- -��� <br />-//�-..y/-- ._� _t_--- <br />Proled Address lil known! �_�---�v= y�---J---`--�-1��� <br />A�taeh �our 14) coP�es Of qlans foi prnPosed w�r.: - D�av: I;i -�.:,i��,�..�n.i nc:!�:� ihr'ollc:vinq as anUhcah�e <br />• Prpperty LineS • Cenb�rlinn nl s;ree� <br />• Ou�line and dimensions ol all existmg and • I�'diC3�•i Norih <br />proposed strucWres on the Io� •�novr anY r.roposed �,7rari�n�? ahenges <br />• Exlstino and proposed utilities • Shnw measurements <br />IS LINE <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259-8810. <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Consiruction <br />Standards and Specification;. <br />3. Call Location Underground Service 48 hrs. betore you dig. TOLL FREE NUMBER 1•800-424•5555. <br />�f , /�%aJ 1/��liGw�'`� <Sh�i �� � l'-r n'/7x; N'r �''"� � �' •� <br />S7L�' �/`bv� <br />�,`�e �-nd s����� ! e�1-� r� /� 4 S/�' <br />-� �-7. .— C'�; ( � 3<3 �1- %�� �riC� -� f-�'"�',�n� <br />3 . <br />CGy, G�t�. <br />C� <br />FINAL INSP1�nuN � <br />Approved as Constructed <br />/A`�;� PUBLIC WORKS DEPARTMENT <br />3200 Cedar Street <br />Eveiett. WA 98201 <br />Phone:259-8870 <br />ACKNOVvLEJG[CtENi i)F CONDITIONS <br />W <br />� <br />� <br />� <br />� <br />O <br />� <br />� <br />� <br />a <br />1 hr• �in�f.=rr�oned ownei!�pP���'�'� he�eby agrees to hold and save harm- <br />-�----- "��- --� -� I,•;s ;I���� iety n� Everett from any and ali claims for damages. costs. <br />., expenses o� causes of action that may anse because ol installation <br />and maintenance M the �mprovc�neM o� other righFo���vey use heretn <br />/z �_fJ I�rpi�n;: t�r and fi,rthar ,�,r.,•?;. to �smove samn_ upon notice Irom ihe <br />o.-,- c,.; ,,:; �� ����i.,�: �>,��y� ,.,.n',�Y damag Crcrr%u <br />�—�-- Sy �j C � ,/ <br />l D,�!" r I /, . �� y - S <br />� S� ti � - pplican! ; Date <br />�!NpR4: AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />' 78p DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />�� 3E DILIGENTLY FURSUED TO COMPLETION. THIS PERMIT MAY BE <br />, C4^JCELLED 9'f THE CITY UPON FNY STOPPSdE OF WORK ON THIS <br />i PRO.IECT OVER 90 DAYS DURATION. <br />