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Datc ''�G•i'�i -,97 <br />Anolication Fur <br />PUBLIC WORKS PERMIi <br />Print or Type Only <br />� f'�scz,v%k�., <br />� <br />Appllcant <br />n9 <br />Meiling Address <br />���� ;a� . ._`�- <br />i�.����, w .�. �,.,m, . _ ��7– 2// <br />���,�,� ��,,,� � - - - -- — <br />�'ubhtWo�heinr s <br />1�IId1 �9C <br />•'.5 A01" i!! PB�tt .� �` <br />nai.i�:e[ue S `���—n <br />�_��-�, ,�� 11� �,���,� �I��-3ytiy. <br />Cily Zip fhone <br />DescribeProposedWork_ ��'� � b2�L����7'' _ <br />Projett Address Of knuwn� 5�- �-���� •__ 7����%��� OF /1� �,.(�f .s _F- <br />Attach four (4) copies ol plans lor proposed work - Drew lo scale enA note the followinq as applicable:`����� J���E, <br />• Property Lines <br />• Oulline end dimensions o� all nxislinq and <br />proposed structures on the lot <br />• Existiny and proposed utilities <br />PERMIT CONDITIONS <br />• Centerline of streel <br />• Indicote North <br />!� Show nny proposed gra�in� chan�r.s <br />• ShoW measuremenis <br />1. All cells lor inqpection shall be made 24 hrs. m advanr,t - phone ZrJ�I•SB� J <br />2. All work shell be perlcrmed in eccordance with Ihl9 pemnl und current City cl [veretl Design ;�nd Conslrur,tlon <br />Slendards nnd Specilicatlona. <br />3. Call Location Underground Service 4P hrs. belore you dig. TOLL FREE NUMBER 1•B00•424•5555. <br />Y�- c� �,�a,M9,Y or�'�-�`'��-���„�/.;� c c�r.r c��,� %i/ <br />��� �� �Si�.=y� — /�,r�.����� iy,t=—z-fi /'�,Jz-ci <br />F%c c�� �s<,�/'i, <br />�� � �� - � �� ���� � - • <br />- _ / i <br />Apprp AforConstructlp ' De�e <br />/ � <br />FINAL INSPEC� � D� <br />Approved ns CansUucied � <br />�\ <br />e��.��.�� PUBLIC WORKS DEPARTMENT <br />� 3_np Cedar Slreet <br />Everell. WA 98201 <br />Fhone.259�8815 <br />ACKNOWLEDGfMENi OF GONDITIONS <br />� <br />� <br />N <br />� <br />O <br />♦�A <br />�♦ <br />O <br />a <br />The undersigned owner/applicanl hereby u9rees lo hold and snve harm- <br />lass ihe City ol Everett Irom nny end nll Gaims for damages, costs, <br />��vpenses, er causes ol aclion Ihnl mey �risa because nl installntion <br />anA mainlen2ncr, o� �he improvement or olher �ighl�of�way usc herefo <br />npplied �or end lurlhe� agreec to remova same upo�� notice Irom Ihe <br />Ciry and �o replece public property Aamnqed Ihereby. <br />� �� -1-(�-��� <br />Si �e w� of A� licant Date <br />WORK Ai�7HOF7ZED �V TFIIS PEHMR MUS'. BE START6D WITf11N <br />18J DAYS OF ATE PERM17 IS ISSUED AND THEREAFTER IS �O <br />BE DILIGFNTLV PURFUEO TO COMPLETION. THIS PERMIT MPY BF <br />CANCELLE7 BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br />PROJECi OVER 90 UAYS DURATION. <br />