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Date��5� <br />Ap�llcation For <br />PU�LlC VNORK� PEFillfll�' <br />Print or Type Only <br />�� , , i ,;; ,-,-• • <br />US /l�'�'� � �J� �ti L!: ,�L-. �-tL 1.'�,t. L: / <br />c�. .. <br />....__. Mailing Address <br />Address <br />�rr'S = ''� <br />punlic vlorks Peime e / `— -- <br />l.! ✓' <br />BIda.Deot.x ___�_S�_ <br />PublicWa�ksfne $ <br />Tolal Feo <br />Loss A�P� Foe Peitl S— <br />oaience oue S �f7 �iC% <br />� <br />Phone <br />4j1 • ••• <br />//✓5%rjlc :i5 � !C�'�i�f%�/��`t.:=��= ��/vC-cv;, <br />Describe Proposed Work <br />�..-� -- „���� i Z/ Ln% �, <br />Prolect Address (it known) ! -� �� � ^ <br />Attach tour (4) copies ol plans for proposed work - Drew to scale and note the following as aDPlicable�. <br />• ProPerty Lines <br />• Outline and dimensions ot all exisl��ng and <br />proposed siructures on thF lot <br />O Existing and proposed utilities <br />G:a''' <br />• Cemerline ol street <br />• Indicate North <br />! Show any proposed grading chan9es <br />Y Show measurements <br />PERPd1T CONDIT!ONS <br />1. All calls for inspection shall be made 24 hrs. in advance - pY�one 259•8815 <br />2. All N�.k shall be performed in accordance with Ihis permit and current City ot Everett Design and Conslructlon <br />Stand3rds and Specitications. <br />3. Ca!I Location Underground Service 48 hrs. before You dig. TOLL FREE NUMBEFi 1-800•424-5555. <br />� . � �� <br />'�' ,l �Ji�c:'Z�.�'`'"�=. i <br />Approvetl tor Construction Date <br />� <br />5 — � a �t'�5 <br />FINAIINSPECTPJN \ Date <br />Approved as Construcied � <br />everet[ PUBLIC WORKS CFPARTMENT <br />3200 CedarStreet <br />Eve�cll, WA 98201 <br />Phone: 259-8815 <br />AGhNOWLEDGE�dENT OF CONDITIONS <br />The undersigned cwner/apU�icaN hereby agrees to hold and s. ve har�n� <br />Icss the City of Everetl Irom any and all claims tor damaces, cos;s. <br />ezpenses, or causes of action lhai may arise because of i�istallatiun <br />and mainlenance ot the improvement or olher ri�hhof-way usc hereto <br />applied for tmd turther agrees �o remove same upon nolice from the <br />y an to raplace P blic property dama9ed lhereby. <br />4 y � —_ � 7�� <br />Si aturE of hpp ic t Date <br />ORK AUTHORIZED BY THIS PERMIT MUST BE STARTE�J WITN'V <br />180 OAYS OF DATE PERMIT IS ISSUED AND THEREAFTER �� '" <br />BE DILIGENTLY PURSUED TC COMPLETION. THIS PERM: i� UAV 13c <br />CANCELLED B'! THF CITY UPON ANY STOPPAGE OF `DONK O� TI-i�-` <br />P90JECT OVEiI :�r0 G1Y5 DURATION. <br />z <br />c <br />� <br /><� <br />m <br />�. � <br />� �. <br />�, _ <br />0 <br />m <br />co <br />mc <br />c� <br />--i c <br />o� <br />-i z <br />_ -i <br />m <br />.o z <br />c <br />a -� <br />�� <br />--I � <br />< <br />� <br />oy <br />-1 t*i <br />x <br />m �, <br />0 <br />v <br />U r <br />.n m <br />C N <br />f3*I V <br />z c: <br />-i r <br />m <br />a <br />x <br />� <br />_ <br />x <br />L <br />� <br />S <br />V' <br />C <br />C. <br />� <br />