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Date�c�$ <br />RUBLIC <br />Print or 1'ype Only <br />It� r�G��a�_r!„T <br />Owner <br />.�p.Q�v.y�� 1_r.wt,r�/_'h <br />Applic nt <br />Describe Proposed Work � <br />Project Address (il known) _ <br />AppliC�an For <br />WO�I�S <br />d <br />O <br />O <br />TO POSTING Z '°°'�°W°,ksPa,m��� ��' v <br />L� C� <br />�BIaB. Deol. • �.�9_[ �7 �� <br />PERMIT <br />m�u�m�u <br />;C C�1 C'J CJ D� `O <br />v�i' o���°�a,' <br />od�o�mU� <br />c�i w«. ra u� rn <br />%?� 5 �-,[, %,� n,�� <br />M2.,,.j'r ing �14�k5LL9 �� n� � <br />O O F-- H �— W <br />\ Oii33ia.� <br />h/''7 Yt pr a. fi � <br />. �-i�% i�2;X- .. �� <br />Mailing Atldress <br />Zip <br />City Zip <br />m <br />Attach four (4) r,opies ot plans for proposed work • Draw to scale and note the following as applicable: <br />• Properry Lines <br />• Outline and dimensions of all axisting and <br />proposed stri ctures on the lot <br />• Existing and proposed utilities <br />Fc� <br />Toial Fee � <br />LessAp�l. Fee Paitl g C <br />�alanre Due $ . l� <br />• Centerline of sireet <br />� Indicate North <br />• Show any proposed gradiny changes <br />• Show measuremenis <br />Plione <br />Phone <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 peAormed in accordance with ihis permit and current City of cverett Design and Construction <br />Standards and Specifications. <br />3. Call I.ocation Underground Service 48 hrs. before you aig. TOLL FREE NUMBEF. 1-500•424•5555. <br />�� ��t;�— GI,/?pYu�! ¢ i� �:�5' ��1 ��I� <br />/�/ � � <br />� ��U� � � <br />���f^ Q�'I <br />��V e�`v .� s <br />1I ����ti,,ro� � t'� �� <br />� , ��( �� ��,r� <br />� � <br />FINAL-tiQSPEGTION <br />Approved as Constructed <br />evereit PUBLIC WORKS DEPARTMENT <br />� 3200 Cedar Street <br />Everett, WA 98201 <br />Phone:259�8810 <br />Date <br />�Ln <br />� - 20 • �' .� <br />���� <br />����� � <br />/I� ���o��� � <br />d J� �� � /�t� <br />'r <br />���1 �W� �, � � � � � �� �/�; <br />� p <br />5'����p�� �5�������� �,J�✓�/ I�����Ci <br />c J i �,�� � ���� s <br />��jer AD�OWLEDGEMENTOF�ONDITIONS�Q��' <br />W <br />F- <br />� <br />� <br />O <br />� <br />� <br />� <br />�� <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City o( Everett irom any and all claims lor damages, costs, <br />expenses, or causes of aciion ihat may arise because of installation <br />and maintenance of the improvement or other right�ohway use hereto <br />applied lor and further agrees �o remove same upon notice hom �he <br />City and to r�e pukilic�operly damaged thereby. <br />l�i�—, ,V �: A,� 1 / I l� ?S <br />Sign2lure of Applic N Date <br />WORK AUTHORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1�0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CiTY UPON ANY STOPPAGE OF WORK ON THIS <br />FROJECT OVER 90 DAYS DURATION. <br />