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�at��y <br />� qpn��cacion Fo� <br />PUBLlC V1lORKS PERMI�' <br />Print or Type Only <br />' _�, _. �. _. �t � <br />/ / %. <br />� <br />/:3.•y..�4. • �f., n� _1.... <br />,.��d. � , �� � . �•�-.� _ <br />ApplKent <br />D �scribe ProOoeed Work � � • "' <br />Pro�ect AdArese (if known) <br />� I/ °� ��Kc�o �/p_ <br />Meilinp Address C �Y <br />� �-.��'.<<...o .__ ,- <br />Mndin9 �ddiess . Cdy <br />) �. /�-. �_ <br />-�^�'� ,i L `. r <br />-�—- �.5_ <br />�v k� <br />��,.�,� wo," � �_-_ <br />Biap �eo� • � <br />puM¢wod�Fes : '�A.�� � <br />iob�Fee I� <br />�xee ADO� «e Pa�J � �— <br />B�bnca Ow � '�Q � � � -- <br />68137 <br />/T 5✓>•'/ �S i - //�^ H <br />�ne <br />S-io � �.i 7 i - .�c. �.-. <br />P Phone <br />Attech lour (A) coples o1 plans lor p�oposed work D�aw to scale end notn � Ceniterline of stPe�i,cable. <br />• Properly Lines • Indicaln North <br />• Oulline end dimeneions of all eaisling nntl � Show eny propOsed grediny cha�ges <br />proposed s�ruclures on the lot t Show measurerants <br />• E�IsI�aN end prOpoced ulllitles <br />— .���—� <br />?cRM1T CONDITIONS <br />I. All cells lor Inspaction shell be made 24 hrs, In advenca � phone 25�•88i 5. <br />2. All work shall be Darformed in eceordance with this peimit and eurrent Gity ol Everelt Des�yr ����A Cons�ruchan <br />Stendarda end Spacificr�tions. <br />3. Cell �ota�lon Untlerqround Service 48 hrs bebre ynu A�g. TOLL FREE NUMBER 1•800•424•5 • <br />"� � / ✓� - iG .,�% <br />��r '� C ./�"'-'�r� DBte <br />App�oveC lor Const�uctior <br />c,� � ' 'Gll�,� .ti� .r � : <br />. , , . _ <br />FINAL INSPECTION I ete <br />Approved es Constructed � � <br />rvrrct[ PUBLIG WORKS DEPARTMENT <br />� 3200 Ce�er Strr,e.t <br />Evcrett N A 9ft20� <br />Phone.25g.q81'. <br />� <br />�r <br />■ <br />N <br />� <br />a <br />ACFNOWLEDGEMENT OF GO�IDITIONS <br />Ttin un�fc�sirn�tl owner/npp�itent hnreby &gree5lo hold end 9ava h� .,.� <br />less Ihe City ol Everetl Irom any anA all cleims lor aa��ee�9, �o5�s. <br />r+perees, or causes ol action thel may erise ber,ause ol Inalnlletion <br />entl m�+intanance ol Ihe improvemr.n� o� olher nqhFobway use herelo <br />ep0lied fur and I�irthar egreas to remove sema upon notice Irom Ihe <br />Gily and Io replece publiC property demegad ihn.reby. j/ � 4 <br />f'Y�- /� < _ `' ---" t <br />� Dnte <br />Signature cf APPlirenl <br />N ORO YSTOF DATE PERMIT SESSUE� ANDBTFiEREAFE6R �S TI� <br />BE DIUG[NTIY PURSUL-D TO COMPLFTION TIIIS PER:dIT MAV �E <br />CANGELLED 0� 1 H� GTV UPON ANV STOPPAfiG OF WORK ON THIS <br />PROJECI� OVLR e0 DAVS DUR�TION <br />�, �- <br />y .. <br />H r <br />rn . <br />oE <br />�� <br />�f <br />�� <br />� <br />H 1 <br />�3 <br />'�7 ; <br />Q <br />�: <br />