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Date__-t_IL1__V l <br />Applicahon For <br />PUB�IC WORKS PERMIT <br />Print or Type Only <br />C I ��a �iP� �i <br />oW�ei <br />t�l� 1P <br />AppGtant <br />�i�� �-���`��� Y-1/� <br />Add�ess Ciiy <br />Mailing Address <br />Ciry Zlp <br />� ,• �•. ..., �,., _ ` � <br />����� �,,,;�� . _ a_� L�.�-- <br />PuhL[Wp�46�ef s <br />101q1��0 <br />I.n: nnn� fae Pnia $ <br />Oninnce �uB .i <br />ne <br />Describe Proposed Work ���� �[ I�� __ <br />Project AAdress (il known) <br />Atlar,h lou� (A) copies ol plans lor p�oposed woik • Drow to sc�le and nole ihe lollowinq as applicable. <br />• Property Lines • Cen�eiline ol strcet <br />• Oidhne and dimensions of all existmy and • InAicatc+ Norlh <br />Uraposed s�ructures on the lot • Show any proposr.d gradine� changes <br />• Cxistinp ond proposed utilities • Show mcasurements <br />PERMIT CONDITIONS <br />1. All calis for inspeclion shall be made 24 hrs. m advance � phone 259•$B� 5. <br />2. .411 �vork Sh011 be perlormed in accordance with Ihis permit antl currenf City ol Gveretl Drs�pn anA Cons�ruction <br />Standards end Specilications. <br />J. Call Loca�ion Underground P,ervice 40 hrs. beloie you dig. TOLL FREE NUMBER 1•800•424•5555. <br />� � �f3��/�� �G ��7 /'.E_S <br />��( ,r.%3)i..--- /,%�f .�(-' �j'C %<i`� <br />'�% �J/5'% <br />� <br />�" l, , <br />— __.. _ _.___.-_______ <br />App�o'�od foi Consiruchnn Ua��� <br />FINAL INSf ECTION D�le <br />�pproved as Construcled <br />�wrrrlt PUBLIC WORKS DEPAHTMENT <br />� 3200 Cedai Street <br />[vere�i, WA 9f3701 <br />f`h:rnn : `�n Hf1ib ��r.11��, <br />r1CNN0\NL[DGEMEM OF CONDI710N5 <br />� <br />O <br />i tv� und��� �.,�q���•�I ownedapplicanl hereby ogrees to hold and save harm� <br />Ir�ss Ihe Cily ol Everett Irom any and nll claima for damnges, cosls, <br />expenses, or causes ol nchon Ihnl may ense 6ecause ol inslallation <br />and mainlenance ol Ihe improvement or olher righbof�way use her�lo <br />npplied for and lur�her agrees lo remove same upon notice from thc <br />Gty nnd lo replace public property damaged thereby. <br />Sic�nalure ol ApPlicant D�te <br />WORK AUTHOFIZED BV THIS PERMIT MUST BE S7ARTED WITHIN <br />180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />f3E DILIG[NfIY PURSUED TO COMPL[TION. THIS PERMIT MAV E31" <br />�;A1�1Gl�.I I ff1 BV TH� GTV UPON ANY STOPf AGF OF 11�ORk pN IIIIS <br />I�Hi-�.II l.I 111'1 q`�U 1�,1Y'; UUHAIIUN <br />