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Date�`������ <br />�pplicntion For <br />RUBL�C VI/OF�KS PERt►JfIT <br />Print or Type Only <br />„ <br />C.��, ����L, I L <br />Mailing Address <br />Pu�Lc Woiks Pormil • '� F _y�__.__ <br />o��n oeoi. x . <br />PuOhc Worhs Fno � `a' ��l � <br />Tolal FOa _7C � <br />Lett ApPI F.,i• Pa�J S � f�_ <br />U.tlOno. Uuc ..S '1 �� � � _ <br />; ,S ����'� /�'L- ��'rl i' � (/�6'ti'rG <br />Ci!y Zip Phone '/'/ <br />%7 �—L-•�T7 <br />S�}hl� <br />Applicant Mailing Address Cily Zip Phone <br />GGr_�2/NG =� <br />Describe Proposed Work _ <br />� �, :a- _n .`�2c�,1�, ZA� < , <br />Prolect Address (it known) <br />,�r�`N„�iU 3�«sN �- s; �>��. <br />�_ /-�-/l� � % L�/l-� //`7 .O2 0� � <br />L✓ , - � c �f"i2 �= �� <br />A�tach lour (4) copie� of plans lor proposed work -�raw to scale and note the following as applicable: <br />• Property Lines • Centerline of slreet <br />• Outline and dimensions of all exisling and O Indicate Norih <br />proposed structures on the lot • Show any proposed grading changes <br />• Exisfing and proposed utilities • Show measurements <br />PERMIT CONDITIONS � <br />t. All calls (or inspection shall be made 24 hrs. in advance - nhone 259-8815. <br />� 2. All work shall 6e performed in accordance wifh this permit and currenl Ciry of Everett Dcsign and Con;Uuc�ion <br />StandarGs and Specif;cations. <br />3. Call Location l:nderground Service 48 hrs. belore you dio. TOLL FREE NUMBER 1-800•424-5555. <br />'c(". �Y O,i/C�YV �"OYI Nt��' � /1G� � ! (� .� /i�i(: L','�Y. <br />/ / / <br />5'. C�ecr/n/ o�' /j r �5 �i "l- S�u n'+�s' aY+ / ��r-�u 4�,� <br />C� .�Q � r n i r� /�r/!� �� J�`�'t� �-4 e� �� 1 /� � �-e l�%e�rs /to/� <br />�� l' L/ / <br />%. /�/�Cl�i7 �clil� �� S ��cJ� S-['7 4YiC' f� ��cM� dr�c i�za r'--�- <br />5 C.tJR �'�- — ,�/O �' �-PGc TiI'� % �— <br />/� G����_� �� -���--- <br />,�� �, ��, <br />nc�<rao N�co�eMEr:T or cor�oino��s <br />�' <br />The undersignetl owncriapplicaM hereby agrees to hold �nd save harm� <br />less ihe Ci�y of Everett Irom any and all claima for damag�s, ccsts <br />"�.C, expenses, or causes of action thal may arise because of installatior <br />_�� and maintenance of Ihe improvement er other righbof-way use herelu <br />applied for and lurther a�rees to re ove same upon rotice Irom tlie <br />Date Ciry and �o replace public property d�naged thereby. <br />FINAL�INSP�C-T(6N�� ' `/ l-`� // i ' Dnte <br />Approved as Constructed • <br />eveiett PUBLIC WORKS DEPARTt.AENT <br />� 3200 Cedar Sireet <br />Everett, WA 98207 <br />� Phone:259-8815 <br />— Z —.7 L <br />Sign tpre o Applicant � Date. <br />WO�K�Yt hIORIZED BY THIS PERMIT MUST BE STARTED WITHIN <br />1B0 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DIL IGC-NTLY PURSUED TO COMPLETION. THI� PERMIT PdAY BE <br />CAPICELLED BY THE CITY UPON ANY STOPPAGE (iP WORK ON THIS <br />PROJECT OVER 90 DAYS DUR�\TION. <br />