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- <br /> � <br /> p� � <br /> Date�'"I 1'U D Public Wo�ks Permil a ��—�� <br /> Applica;�nn r o� eme.oeoi.. � �_ �. <br /> �9� ���C ����1a�+..F �7�G`=�� �7 Publ¢WorNSFce �i <br /> � Total Fce g . <br /> Less Appl Fee Paid w4 _ ' <br /> �C �� i <br /> Print or Type Only o��,���o�� s _ <br /> �' � �(�?�`�' �D15 ��d_�,_��:��L t� _ � �,���'.� <br /> Owner Mailing Address City �iU Phone <br /> �'LYl't� _C'P]_[_=`=�� <br /> Applicant Mailiny Address Ciry � '� Phone , <br /> Describe Proposed Work e_>�f< L lJ� I l j�� ��`� ,,. _ _ <br /> Project Address(if known) - / � ` /��Z<�/C SF � <br /> � <br /> Altach four(4) copies of plans for proposed work- Draw to scale and note the following zs applicable: �� <br /> • Property Lines a Centerline of siree� � <br /> • Outline and dimensions ot all existing and @ Indicate Norih <br /> proposed struclures on the lot • Show any proposed grading changes <br /> ! Fxisting 2nd proposed u�ilities • Show measurements � <br /> �— <br /> DO NOT WRITE BGLOW THIS LINE <br /> PERMIT!,'ONDITIONS � <br /> 1.All call,for inspeclion shall be made 24 hrs. in advance-phone 259-8810. � <br /> 2.All work shall be performed in ac�ord2ace with this permit and current Ciry ot Everett Design and Constructior� <br /> Standards and Specifications. <br /> 3.Call Location Undergroun•I Service 48 r.r•� t,fore you dig.TOLL FREE NUP98Eq 1-$00•424•5555. � <br /> '1 , !'ahlY CH��I`dGE IIV TfIE DI;:It�r_wnl' CUT I•1UST ;_.�_ ��rr�r.�a'l�:i> <br /> +:`( 'THC F'UBI_.]'r 'vJOF1:S IP,I^-;PECTOIi, � <br /> �.,. �ISE 1=I_;BLIr L 1:",INAGE SYSTI=i�( �'1S ^F:OVTi;FT) PDF Di?�dI.ISF'f]I.JTE.?.. <br /> . ,1N1' I_Ol' Gfi(-1DE CI-IANGES 1�1UST [{E AF'F'RDVED I3Y TI 1E ' <br /> � 'UELIC WORI':S II'd51'F_CTOF•'. � ' <br /> I :E�P CI:TI' ;TI(EF'fS CLEAh•.I F,T f11_L l'II`1E�3. ' <br /> . Ti �"T�'�LI_ WP�7��F� EU"rS l �� ��'':1DI ill' Tl�f ' �II1 � �I- I;f)hl� T-:I,If�-r7 l� � <br /> i, l`h ' :�: 51J4E DF�I�� � i. � .,_ � �I �'0! ' ' "I ',=L ' �i �.i., r i.. ! U9'i- <br /> _ �r)I-• r V'I:Pdf:i I,I`.I '�'�..iC.P1. <br /> � <br /> AGKPJO�NLGDGEI��IENT OP CONDITIONS <br /> The undersigned ownedapUlicant hereUy agreus lo hold and save horm� <br /> — -- h•s;; the City ol Gverett Irom any antl all claims for tlamages, cosis. <br /> i . ', ' � expenses, or causes ol achon that may arise because of installation <br /> ���J'j i % � and maintenanr.e of ihe improvemenl or other righFohway usc heralo <br /> ��;'/�' i��-:7'rZ'i'�y -'/—�i�'� <br /> applied for and lurlher agrees lo remove same upon notice hom ih�� <br /> Approved r-,Consiruction Date City and to replace public property damaged thereby. <br /> /� // . <br /> �-`G�..vt F//�E,' G—1 i�L S 'C /� / ,,�/ 'J <br /> FINAL INSPECTION Z�� ate G.C� 7 ✓�__— <br /> Approved as Conslruc�ed Si n.Wre of Appli ant � Dato <br /> everett PUBLIr,yyOFiKSDEPARTAIENT WORK AUTHORIZED BY iHIS PERAtIT MUST BE STARTED WITHIN <br /> � 3200L:edarStreet 780 DAYS OF DATF PERMIT IS ISSUED AND THEREAFTER IS TO <br /> Evereti,WA 98201 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY B[ <br /> Phone:259�8810 CANCELLED BY THE CITY UPON ANY£TOPPAGE OF WOFK ON THIS <br /> PROJECT OV[R 90 DN'S DURATION. <br /> . - - ��0��. <br />