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Date1L�.�/' -j <br />Applicalion For <br />PUBLIC WORKS <br />P� int or Type Only <br />�. . ��h,_ ,_L, � �� .� . .. <br />Owner <br />Ma,;ing <br />��� 1 � <br />PERM ITr �` �f��:,;,�,,, -� <br />i ��' r�.+ 1 � t' �/ <br />� <br />L ---- <br />i /� " _ � <br />',> 'j ; ,:d(, � <br />Pin•ni Wmxe Pxrmq • --- <br />m�v c�ni . 3 / � � 3 <br />Pubhc Worh�Fae 6 — L� — —. <br />iol�l ine <br />i�ee �oo� Poe Pe�a S <br />Belence Oue s ^ U <br />Phone <br />i t ,� _ <br />i � <br />Appllcanl Moiling Address City Zin Phone <br />���'� �;.: �� � i.'ii ir rii�F � ,� ; /'l' , . /� <br />Descrihe Proposed Work <br />Prolec� Address (lf known) � � � <br />�:; , �, <br />Altach lour (4) copies ol plens lor proposed work � Draw lo scale and nole Ihe following as applicabie�. <br />• Proparty Lines • Centerline ol streel <br />• Outline end dimansions oi ell esisting end • Indicate North <br />p�oposed siructures on the lot • Show eny proPosed greding chenges <br />• Existing end proposed utililies • Show measuremen�s <br />PERMIT CONDITIONS <br />t. All calls br Inspection shall be mnde 24 hrs. in aAvance - phone 259•881 5. <br />2. All work shell ba parformad in eccordance with this pe�mit and currnnt Clty ol Everett Design and Construction <br />Standa�ds end Specilications. <br />J. Call Location Underground Service 4B hrs. 6elore you dig. TOLL FREE NUMBER 1•800•424•5555. <br />m <br />FINAlINSPEGiIUN �� \ <br />Appraved as Constructed <br />evrrrll PUBLIG WOHKS DEPARTMENT <br />� 3200 Cednr Streel <br />Evcrett. WA 98201 <br />Pl��nr.' 25y�1i(i15 <br />W <br />H <br />� <br />N <br />� <br />O <br />� <br />N <br />O <br />a <br />ACKNOWLEDG[M[NT OF CONDITIONS <br />The und��is�gned ownednPPlicenl hereby agrees lo holA end save harm� <br />Icss Ihn City ol Everet� irom any and all claims lor domages, cosls. <br />e*nenses, o� causes ol ection that mey erise bacause of instnllalion <br />and mninlenpnce of ihe imOrovemenl or other nght-obway usr hereto <br />epplied lo� and luriher egrees lo remove same upon notice fiom the <br />CIf9'H1M�o replacr. pubyc p�operty damagod Iheroby. <br />�� /d��rj <br />t re ol Applica ua�e <br />RK AUTIiOR12ED BY THIS PERMIT MUST BE SIARTED WITHIN <br />80 DAYS OF DATE PEI7MIT IS ISSUED AND THEREAFTER IS TO <br />BE DILIGENTLV PUASUED TO COMPI ETION. THIS PERMIT MAV B[ <br />CANC[LL[D �Y THE CITY UPON ANY STOPPAGE OF WORK ON iH15 <br />PROJPCT OV[R 90 DAVS DURATION <br />