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D819'�c� <br />Applica6cn Fnr <br />PIIBLIC WORKS PERlV16T <br />Print or Type Only <br />hng <br />� Qh- <br />qppliCant � Ma�hnc� AAdiess Ci�y <br />i <br />Put�br W��rtn (.rm.i � _ � ��� <br />Di�B DeO� � __—__" <br />�u�tl--,Yo:b:�e� / -�C�_.. <br />to4ifr. S _._L�� _. <br />less Anui f �� Pm� S <br />nam�� � n�,.• S <br />-/�7 `' -- <br />%3's'a�� 7�� 8 69�J <br />Zin Phan? <br />Phone <br />Describe Proposed Ncrk ��p � �'�� ��/� �i� ��G L� _ <br />— �,S'i���-�i< r oN,� c�NT/� <br />_ �_�f�T/l4-�c�E'/.�i'/T� /.T.S'uc.p <br />----� - <br />P�olect Address Id Imownl _��`��. :,_G�C t- _ <br />Atfar.h lom �41 copius oi olans lor proposetl work � D�aw �o scale and note Ihe following as apPlicable�. /P(� <br />• Property Llres <br />• Outhne and dimensions ol all e.isimg antl <br />proposed stiuclures on Ihr. lot <br />• EM�shrg and proposed utildies <br />• Ce iteihne ol sireel �� <br />• Incicale North <br />• Sh �w any U�oposed grading changas /�/ � D <br />• Show measuremenis r O <br />PERMI7 CONDITIONS <br />1. All cells lo� Irispectlon ehall be mede 24 hrs. in advance - phone 2J9•881 O. <br />2. Atl work eheL be perlormed m accordance with Ihis pe�mll and current City ol Everett Design and Conslrucflon <br />Standards erd Specificetions. <br />3. Call Locetlon Underground Service 48 hrs. belore y�u dlg. TOLL FREE NUMBER 1•B00•424-5555. <br />� <br />S_ <br />s���t'i�� oiv�y ��-� ��-p� <br />��� �,�/� <br />�/� �-jL G O/J S i% c� ci/�i � G <br />CY� n�5'%�lC %lUn� �=� /i�'%f�� c �i`�� <br />v <br />�c=.E'cJS'/D n� C'G'' it�r"�i"'G //�! %,��C ^ / <br />7� �t3y —' `�/�- � uoao^�s� <br />�/�LS%�T I/"�' � • UFT.�� <br />CHICf; <br />FINAL INSPECTION � � ' <br />Approved as Constiucted <br />evemtl PUBLIC WOflKS DEPARTMENT <br />� 3200 Cetlar Sireel <br />Everett, WA 99201 <br />Phone:259�8810 <br />/ L L� <br />Date <br />':U1PN UOOAHB6:2 <br />g11i.U0 <br />411'I.OI' <br />ACKNOWLEDGEMENi OF CONDITIONS <br />W <br />� <br />� <br />0 <br />� <br />� <br />et <br />a <br />The under5iyneA o�vner/applicnnt hereby agrees to hold and save h.unr <br />le:.s Ihe City ol Ev�retl liom any antl all claims for damages, costs. <br />evpenses. or e ses ol , cUon �hal ma�y anse because ol mslallalion <br />and mainten cc ot Ihe impiovemenl or olher ngM�ol�way use herclo <br />apphed lo�nd Iwther agree.s to remove same upon notice �iom the <br />Gty and�Yo repl�/eytfl�lic property damaged Ihe�eby. <br />ynal e ol Applicant � Date <br />O AUIHORIZED BV THIS PERMIT MUST BE STARiED WITHIN <br />0 DAVS OF DAiE PERMIi IS ISSUED AND THEREAFTEfi IS TO <br />BE DILIGENTLY PURSUEU TO COMPLETION. THIS PERMIT MAV BE <br />GANCEI LED BY THE CITV UPON ANY STOPPAGE CF WORK ON THIS <br />PFWECT OVER 90 DAVS DURATION. <br />